PBL 5 Flashcards
what is the definition of menopause
No menstrual periods for 12 consecutive months and no other biological or physiological cause can be identified
what is the average age of menopause
51-52yrs
what is early menopause
Early’ menopause = 40-45yrs (20% of women)
what is premature menopause
Premature’ menopause = <40yrs (1% of women)
what other things can cause periods to stop
Sudden weight loss, contraception (progesterone pill, mirena coil), pregnancy, stress, being overweight/obese, extreme overexercising, PCOS
what is perimenopause
The time leading up to and around the menopause, can last for several years.
This is when reproductive function starts to decline
what are the symptoms of perimenopause
Changes in length of menstrual cycle
Hot flushes / night sweats
when does perimenopause begin
If menopause at 50yrs, climacteric begins a year earlier
If menopause <40yrs, climacteric begins 4 years earlier
what causes the symptoms of menopause
Symptoms of Ovarian Failure ie oestrogen deficiency
what are the 2 categories of symptoms of menopause
Short term symptoms
Long term consequences
name the 4 short term symptoms
- vasomotor
- psychological
- urogenital
- collagen
describe the 4 short term symptoms
vasomotor
- Hot flushes
- Night sweats
- Headaches
- Palpitations
psychological
- Depression
- Mood swings
- Insomnia
- Memory loss
- Panic
urogenital
- Urinary frequency
- Dysuria
- Stress and urge incontinence
- Vaginal dryness
- Dyspareunia
collagen
- Dry inelastic skin
- Brittle nails
- Hair loss
- Joint/muscle pains
name the 5 long term consequences
CVS Skeletal skin psychological genito-urinary
describe the 5 symptoms
CVS
Hyperlipidaemia
IHD
Genito-urinary Atrophic changes Prolapse Incontinence Depressed libido Dyspareunia
Skeletal
Osteopenia
Osteoporosis
Skin
Inelastic thin flaky skin
Easy bruising
Psychological
- Alzheimer’s Disease
how do you investigate menopause
Triad of diagnostic features
- Typical symptomatology
- 12 months’ amenorrhoea
- FSH>15iu/ml
Serum oestradiol levels
- Only useful
what is the treatment for menopause
Hormone replacement therapy (HRT)
Non-hormonal methods
what are the two HRT treatments
If uterus present :
oestrogen + progesterone
If uterus absent :
oestrogen alone
what are the routes of administration for the two HRT treatments
Oral Patches and gel Implants + injections Intravaginal creams, pessaries, rings Nasal sprays
what are the side effects of HRT
Heavy cyclical / unscheduled irregular bleeding
Bloating, fluid retention and weight gain
Mastalgia (breast pain)
Headaches, muscle cramps, abdominal pain
Depression
what are the serious complication of HRT
Breast cancer
Risk increases >5yrs of use, by approx. 2-6/1000 women
Thrombo-embolic events
DVT/PE affect approx. 5/10,000 women on HRT, and most commonly occur in the first year of use
what are the contraindications to HRT
Breast cancer Endometrial cancer TED Endometriosis Fibroids IHD
what are the non hormonal treatment
Bisphosphonates & Calcitonin: decrease osteoclast activity
Selective oestrogen receptor modulators (SERM)
Clonidine & Venlaflaxine: Reduce vasomotor symptoms
what are lifestyle changes for non hormonal treatments
Lifestyle Vitamins Herbs Phyto-oestrogens Exercise No smoking
what happens to the sex hormones during the menopause
Low oestrogen
Low progesterone
High LH and FSH
Declining testosterone (with age not menopause)
what age is the MMR vaccine given at
1 year
3 years 4 months
