Menopause & HRT Flashcards
definition of menopause?
- point at which menstruation stops
- average age = 51
when is post menopause?
period 12 months after last period
when is peri menopause?
period of time leading up to last menstrual period
physiology behind menopause
-
reduced development of ovarian follicles –> reduced oestrogen secreted by granulosa cells:
- anovulation
- amenorrhoea
- lack of oestrogen symptoms ie peri-menopausal symptoms
what are peri-menopausal symptoms?
- mood changes
- reduced libido
- vaginal dryness/soreness
- vasomotor symptoms ie hot flushes
- muscle and joint aches
what does menopause increase risk of?
- osteoporosis
- CVD & stroke
- urinary incontinence
- prolapse
Ix?
can do FSH(raised) in women <45years
contraception?
required
- for 2 years after LMP <50
- for 1 year after LMP >50
what forms of contraception should be avoided?
depo provera in >45 as causes reduced bone mineral density & weight gain
Mx of perimenopausal symptoms?
- 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
options for HRT?
- hormonal
- non-hormonal
non-hormonal options?
- CBT
- SSRI
- Clonidene
- lifestyle changes
herbal remedies:
- evening primrose oil
- red clover
- ginseng
Before starting HRT, what should you check
- no contraindications present
- pts BMI & BP
- FH of oestrogen sensitive cancers / VTE
- cervical and breast screening up to date
HRT options
- 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
how long does HRT take to have full effect?
3-6months
how long before major surgery must you stop oestrogen containing contraceptives?
4 weeks
S/E of HRT?
- oestrogen
- breast swelling/tenderness
- nausea and bloating
- progesterone
- acne and greasy skin
- weight gain
- unscheduled bleeding may occur for first 3-6months
what should be done if S/E experienced?
change type of HRT or route of administration
indications for HRT?
- bone protection
- improve symptoms
- replace hormones in primary ovarian failure
benefits?
- improve symptoms
- better QoL
- reduced risk of osteoporosis
risks of HRT?
- breast & endometrial cancer
- VTE
- CVD & stroke
ways to reduce risks
- transdermal - reduce risk of VTE
- local progesterone rather than systemic- reduce risk of breast cancer & CVD
- add progesterone- reduce risk of endometrial cancer
contraindications to HRT?
- unexplained abnormal bleeding
- pregnancy
- liver disease
- breast cancer
- VTE
- endometrial hyperplasia or cancer
- active angina
- uncontrolled HT
