Menopause & HRT Flashcards
What are the 5 stages of menopause?
Pre-menopause Premature menopause = primary ovarian failure (POF) Perimenopause Menopause Post-menopause
What are the endocrine changes during the menopause?
Decline in oocyte numbers
Upper centres still working (hypothalamus/anterior pituitary)
But ovary cannot respond
Negative feedback loop: rise in FSH and LH due to reduction in oestrogen declining follicles
As number of follicles diminishes inhibin declines
Rise of FSH via negative feedback loop
What are the key features of the menopause?
Cessation of menses
45-60 years
Mean age is 51
Decline in ovarian oestrogen production
What’s atresia and what age does it kick in?
Increases from around age 35
There are 1.2 million follicles at birth and 1000 left by menopause
Follicles are mainly lost by atresia, rather than ovulation
What age does fertility decline and what risks does it carry?
Age 37
Increased risk of miscarriage, meiotic non-disjunction and Down’s syndrome
What are the symptoms of menopause due to?
More related to falling levels of oestrogen rather than low levels
What’s oligomennorhea?
Periods space out
What’s it called when menopause cease?
Menopause
What’s the classic symptom triad of menopause?
Hot flushes
Sweats
Vaginal dryness
Affect 80% of women and bother 45%
What are non-specific symptoms of menopause?
Headaches Migraines Palpitations Disturbed sleep Joint and muscle aches
What are urogenital symptoms of menopause?
Vaginal dryness
Cystitis
Urinary frequency
Urinary incontinence
What are psychological symptoms of menopause?
Loss of concentration Poor memory Irritability Loss of libido Panic attack
What are some features of connective tissue atrophy as a result of menopause?
Skin thinning Hair loss Brittle nails Aches and pains Osteoporosis
What are features of osteoporosis?
Loss of bone matrix Loss of height Deformity Fractures Economic cost
How is menopause diagnosed?
Clinically: age, symptoms, signs
If less than 40 consider FSH marker (FSH>30)
Absence of menses or 12 months
What defines premature menopause? What’re it’s risks?
Defined as premature ovarian failure before the age of 40 years
Premature death, neurological diseases, psychosexual functions, mood disorders, osteoporosis, ischaemic heart disease, infertility
What’s the difference between POF and menopause?
POF doesn’t necessarily mean a lack of viable follicles - that’s menopause
POF = disconnect between hormones and ovarian function or autoimmune problem
What are causes of POF?
Idiopathic
Familiar tendency
Autoimmune/thyroiditis
Genetic: Fragile X, Turner’s syndrome
Radiation, chemotherapy, tamoxifen (acts as oestrogen blocker)
Viral infections
Oophrectomy and total hysterectomy which will trigger premature menopause
What’s hormone replacement therapy?
Administration of oestrogen relieves menopausal symptoms
Use natural oestrogen
Sometimes combined with progestogen to avoid cystic endometrial hyperplasia
What are the routes of administration for HRT?
Oral daily
Transdermal patches lasting 2 weeks
Subcutaneous implants lasting 6 months (progestogen is taking orally at specific times to avoid uterine symptoms)
Topical oestrogen creams to treat urogenital symptoms
What are the benefits of HRT?
Improves vasomotor symptoms such as hot flushes and night sweats
Improves urogenital symptoms
Reduces fracture risk and osteoporosis
What are adverse effects and risks of HRT?
Thromboembolism -> stroke Breakthrough bleeding Breast tenderness Increased risk of breast cancer Increased risk of dementia >65 years
What are 2 other drugs that can be used to treat menopause symptoms?
Raloxifene - SERM to treat osteoporosis
Tibolone - synthetic steroid with metabolites possessing oestrogenic and progestogenic activities
