Menopause + HRT Flashcards
Menopause: Definition
Permanent cessation of the menstrual cycle. It is caused by ovarian failure leading to oestrogen deficiency.
Natural menopause is recognised to have occurred after 12 consecutive months of amenorrhoea for which no toehr obvious pathological or physiological cause is present.
Menopause: SHORT term consequences
- Vasomotor symptoms
- Sexual dysfunction
- Psychological symptoms
Menopause: LONG term consequences
- Osteoporosis
- Cardiovascular disease
- Urogenital atrophy
Menopausal SYMPTOMS
Menopausal symptoms are very common and affect roughly 75% of postmenopausal women.
Symptoms typically last for 7 years but may resolve quicker and in some cases take much longer.
The duration and severity are also variable and may develop before the start of the menopause and in some cases may start years after the onset of menopause.
MANAGEMENT of menopause: CATEGORIES
The management of menopause can be split into three categories:
- Lifestyle modifications
- Hormone replacement therapy (HRT)
- Non-hormone replacement therapy
PERImenopausal symptoms
- Hot flushes
- Emotional lability
- Premenstrual syndrome
- Irregular periods
- Heavier or lighter periods
- Vaginal dryness
- Reduced libido
MANAGEMENT of menopause: LIFESTYLE modifications
Hot flushes
- regular exercise, weight loss and reduce stress
Sleep disturbance
- avoiding late evening exercise
- maintaining good sleep hygiene
Mood
- sleep, regular exercise and relaxation
Cognitive symptoms
- regular exercise and good sleep hygiene
Management with HRT: Contraindications
- Current or past breast cancer
- Any oestrogen-sensitive cancer
- Undiagnosed vaginal bleeding
- Untreated endometrial hyperplasia
MANAGEMENT of menopause: HRT
Roughly 10% of women will have some form of HRT to treat their menopausal symptoms. There is a current drive by NICE to increase this number as they have found that women were previously being undertreated due to worries about increased cancer risk. If the woman has a uterus then it is important not to give unopposed oestrogens as this will increase her risk of endometrial cancer. Therefore oral or transdermal combined HRT is given.
If the woman does not have a uterus then oestrogen alone can be given either orally or in a transdermal patch.
MANAGEMENT of menopause: HRT - Risks
Women should be advised that the symptoms of menopause typically last for 2-5 years and that treatment with HRT brings certain risks:
- Venous thromboembolism: a slight increase in risk with all forms of oral HRT. No increased risk with transdermal HRT.
- Stroke: slightly increased risk with oral oestrogen HRT.
- Coronary heart disease: combined HRT may be associated with a slight increase in risk.
- Breast cancer: there is an increased risk with all combined HRT although the risk of dying from breast cancer is not raised.
- Ovarian cancer: increased risk with all HRT.
MANAGEMENT of menopause: Management with non-HRT
Vasomotor symptoms
- fluoxetine, citalopram or venlafaxine
Vaginal dryness
- vaginal lubricant or moisturiser
Psychological symptoms
- self-help groups, cognitive behaviour therapy or antidepressants
Urogenital symptoms
- if suffering from urogenital atrophy vaginal oestrogen can be prescribed. This is appropriate if they are taking HRT or not
- vaginal dryness can be treated with moisturisers and lubricants. These can be offered alongside vaginal oestrogens if required.
MANAGEMENT of menopause: Stopping treatment
For vasomotor symptoms, 2-5 years of HRT may be required with regular attempts made to discontinue treatment. Vaginal oestrogen may be required long term. When stopping HRT it is important to tell women that gradually reducing HRT is effective at limiting recurrence only in the short term. In the long term, there is no difference in symptom control.
Although menopausal symptoms can be managed mainly in primary care, there are some instances when a woman should be referred to secondary care. She should be referred to secondary care if treatment has been ineffective, if there are ongoing side effects or if there is unexplained bleeding.
HRT: Side effects
- nausea
- breast tenderness
- fluid retention and weight gain
