Menopause + postmenopausal health Flashcards
What is premature ovarian insufficency
Menopause before 40
Causes of premature ovarian insufficency
Primary - Chromosomal (turner's, fragile x) Autoimmune (hypothyroid, Addison's, MG) Enzyme deficency (galactosemia) Secondary - Surgery/radiotherapy/chemo infection (TB, mumps)
Why might you get infrequent heavy bleeding in post menopausal women
Infrequent ovulation leading to swings in oestrogen and progesterone concentrations
Non-hormonal treatment for menopause
alpha agonist, beta blocker, CNS modulators (venlafaxine- antidepressant) all for vasomotor symptoms
topical oestrogens - urogenital
Vaginal lubricant - dryness
Bisphosphonates - osteoporosis
What is cyclical HRT
Give oestrogen for 16-18 days
Give prog for 10-12 days
Will menstruate once a month (when on progesterone)
Good for peri and early menopause
Who do you give continuous combined to?
> 54 yrs
known to be definitely post-menopausal
most women don’t experience vaginal bleeding
Benefits of HRT
CNS CVS (small window of opportunity in peri-menopause/ early menopause osteoporsis vaginal tract GI tract (no difference to GI tract) can improve sleep patterns
Absolute contraindications of HRT
suspected pregnancy endometrial/breast cancer liver problems Uncontrolled HTN active VTE thrombophilia otosclerosis
Relative contraindications of HRT
uninvestigated vaginal bleeding fibroids benign breast disease family hx of vte migraine w/ aura
side effects of oestrogen
Breast tenderness
headache
cramp
nausea
side effects of progesterone
acne breast tenderness mood swings depression ?water retention headache
Effect of HRT on incidence of VTE
HRT doubles incidence of VTE
Lifestyle management for menopause
Stop smoking
drop weight
reduce alcohol consumption
Elligibility for oestrogen only HRT
HYSTERECTOMY
if BMI>30 should give it as transdermal patch
risk of HRT
breast Ca (to a lesser extent endometrial)
CVS
VTE
