Menopause & HRT Flashcards
1
Q
definition of menopause?
A
- point at which menstruation stops
- average age = 51
2
Q
when is post menopause?
A
period 12 months after last period
3
Q
when is peri menopause?
A
period of time leading up to last menstrual period
4
Q
physiology behind menopause
A
-
reduced development of ovarian follicles –> reduced oestrogen secreted by granulosa cells:
- anovulation
- amenorrhoea
- lack of oestrogen symptoms ie peri-menopausal symptoms
5
Q
what are peri-menopausal symptoms?
A
- mood changes
- reduced libido
- vaginal dryness/soreness
- vasomotor symptoms ie hot flushes
- muscle and joint aches
6
Q
what does menopause increase risk of?
A
- osteoporosis
- CVD & stroke
- urinary incontinence
- prolapse
7
Q
Ix?
A
can do FSH(raised) in women <45years
8
Q
contraception?
A
required
- for 2 years after LMP <50
- for 1 year after LMP >50
9
Q
what forms of contraception should be avoided?
A
depo provera in >45 as causes reduced bone mineral density & weight gain
10
Q
Mx of perimenopausal symptoms?
A
- HRT
- Tibolone
- synthetic steroid that stimulates oestrogen & progesterone
- Clonidine
- alpha agonist - helpful for hot flushes
- CBT/SSRI
- testosterone - for low libido
- vaginal oestrogen - for dryness
11
Q
options for HRT?
A
- hormonal
- non-hormonal
12
Q
non-hormonal options?
A
- CBT
- SSRI
- Clonidene
- lifestyle changes
herbal remedies:
- evening primrose oil
- red clover
- ginseng
13
Q
Before starting HRT, what should you check
A
- no contraindications present
- pts BMI & BP
- FH of oestrogen sensitive cancers / VTE
- cervical and breast screening up to date
14
Q
HRT options
A
- local or systemic symptoms
- local- topical treatment
- systemic- systemic
-
- no uterus –> oestrogen only
- topical / systemic (oral/transdermal)
* uterus –> add progesterone (combined HRT)
3.
- perimenopausal - cyclical combined HRT
- postmenopausal- continuous combined HRT
15
Q
how long does HRT take to have full effect?
A
3-6months
