Menopause & HRT Flashcards
What the stages of menopause?
- Pre-menopause
- Premature menopause/Primary Ovary Failure (POF)
- Perimenopause
- Menopause
- Post-menopause
What endocrine changes occur at menopause?
Upper centres keep working but there is declining oocyte numbers and the ovary cannot respond causing follicles to diminish which means the ovarian hormone inhibin declines so:
- FSH/LH rise as a result of decreased inhibin and -ve feedback
- Oestrogen is low
What is menopause?
A natural life event that occurs typically at 45-60 year old (~51 years old) when women stops their menses and there is a decline in ovarian oestrogen production in which the process i.e. perimenopause lasts for +/- 5 years
Why does menopause occur?
1.2 million follicles at birth declines to 1000 by menopause mostly as a result of atresia (degeneration of ovarian follicles which do not ovulate during menstrual cycle) which increases from ~ age 35 NOT ovulation
When does fertility decline?
Waves from ~37 years
What are the risks when fertility declines?
Miscarriage
Meiotic non-disjunction
Down’s syndrome/Trisomy 21 (longer time-frame to gain mutations)
What is meiotic non-disjunction?
- Failure of a pair of homologous chromosomes to separate in meiosis I
- Failure of sister chromatids to separate during meiosis II
- Failure of sister chromatids to separate during mitosis
Nondisjunction results in daughter cells with abnormal chromosome numbers (aneuploidy)
Why does symptoms occur in menopause?
Due to FALLING levels of oestrogen rather than low levels
What is the main symptom of menopause?
Wide variation and can be relatively asymptomatic but include:
- Oligomenorrhea (perimenopause) > amenorrhea (when menopause reached)
What is the classic menopause symptom triad?
- Hot flushes due to vaso-motor instability
- Sweats spec. at night
- Vaginal dryness as urogenital tissues are oestrogen sensitive
Affects 80% but bothers 45%
What non-specific menopause symptoms can occur?
Headaches Migraines Palpitations Disturbed sleep Joint and muscle aches Infection
What urogenital symptoms of menopause can occur?
Vaginal dryness Cystitis Urinary frequency Urinary incontinence Vaginal atrophy Dyspareunia Vulvovaginitis
What psychological menopause symptoms can occur?
Loss of concentration Poor memory Irritability Loss of libido Panic attacks
In menopause, connective tissue atrophy can occur. What are the symptoms of this?
Skin thinning Hair loss Brittle nails Aches/pains Osteopenia > osteoporosis
What are the features of osteoporosis?
Loss of bone matrix
Loss of height
Deformity
Fractures
How is menopause diagnosed?
- If occurs at normal age, usually clinically by assessing symptoms/signs
- If a lady is less than 40 years old and menses have been absence for 12 months do blood test for FSH and if above 30mIU/mL POF is confirmed
What is premature menopause?
Premature Ovarian Failure (POF) occurring before the age of 40 years (~1% of women) - does not necessarily mean a lack of viable follicles as in menopause, but there is a disconnect between hormones and ovarian function, or an autoimmune problem
What are the risks of premature menopause?
Premature death Neurological diseases Psychosexual function Mood disorders Osteoporosis IHD Infertility
What menstrual cycle changes can occur as a result of Premature Ovarian Failure (POF)?
Oligomenorrhoea
Polymenorrhoea
Metrorrhagia (bleeding in between periods)
What are the causes of Premature Ovarian Failure (POF)?
Idiopathic
Familiar tendency
Autoimmune/thyroiditis
Genetic (Fragile X, Turners syndrome)
Radiation/chemotherapy/Tamoxifen - oestrogen blockers
Infections e.g. viral
Oophrectomy/total hysterectomy (surgical menopause)
What is Hormone Replacement Therapy (HRT)?
Administration of hormones esp. oestrogen to relieve menopausal symptoms with preparations containing natural oestrogen at lower doses than oral contraception and can also include progesterone to avoid cystic endometrial hyperplasia
What are the routes of administration of Hormone Replacement Therapy (HRT)?
- Orally via daily tablets
- Transdermal patches that last 2 weeks
- Subcutaneous implants with pellets lasting 6 months w/ progesterone orally at specific times
- Topical oestrogen creams applied to vagina for urogenital symptoms
When is progesterone added to Hormone Replacement Therapy (HRT)?
Always UNLESS the patient has had a hysterectomy as in this case, they do not need to worry about uterus symptoms as their uterus and cervix have already been surgically removed
What are the benefits of Hormone Replacement Therapy (HRT)?
Improves menopause symptoms esp. vasomotor and urogenital symptoms
Reduces fracture and osteoporosis by improving ER function in bone, mineral density and reducing osteoclast proliferation
What are the adverse effects of Hormone Replacement Therapy (HRT)?
Thromboembolism Stroke Breakthrough bleeding Breast tenderness Increased risk of breast cancer Increased dementia risk in >65 year olds
What other drugs are available to treat menopausal symptoms?
Selective Oestrogen Receptor Modulator (SERM) e.g. Raloxifene/Tamoxifen which are also used to treat osteoporosis via activating +ve oestrogen-like effects via ER function in bone but NOT in breast or uterus so do not carry with them same breast cancer risk
