Postmenopausal Syndromes Flashcards
1
Q
What is Menopause?
A
- Permanent cessation of menstruation. It is caused by loss of follicular activity. Menopause is a clinical diagnosis usually made in primary care when woman has not had a period for 12 months
- Symptoms typically last for 8 years but may resolve quicker or longer than this. Duration and severity also variable and may develop before or years after onset of menopause. An average woman in the UK goes through menopause at 51 years old.*
2
Q
What are hormonal changes in Menopause?
A
- Pituitary gland releases FSH and LH to stimulate the ovary but the ovaries cannot produce enough oestrogen and progesterone so there is reduced negative feedback to the hypothalamus and anterior pituitary leading to increased GnRH, FSH and LH
3
Q
What are symptoms of Menopause?
A
Change in Periods
- Change in length of menstrual cycles
- Dysfunctional uterine bleeding may occur
Vasomotor symptoms (80%) usually daily and continues for 5 years
- Hot flushes
- Night sweats
Urogenital changes (35%)
- Vaginal dryness and atrophy
- Urinary frequency
Psychological
- Anxiety and depression
- Short term memory impairment
4
Q
What is the Climacteric and Perimenopause?
A
Climacteric
- Period prior to menopause where women may experience symptoms as ovarian function begins to fail. This leads to reduced levels of female hormones primarily oestrogen
Perimenopause
- Time when women are having symptoms of menopause before their final period
5
Q
How is contraception used in Menopause?
A
Recommended to use effective contraception until:
- 12 months after last period in women >50 years
- 24 months after last period in women <50 years
6
Q
What are long-term complications of Menopause?
A
- Osteoporosis
- Increase risk of ischaemic heart disease
7
Q
How is Menopause diagnosed?
A
- No blood test needed if patient is over 45 years but symptoms only
- Blood test could be done between 40-45 years of age
- Blood test should be done if before 40 years of age
Confirmed when serum FSH level are more than 40 milli international units/ml at least twice 4-6 weeks apart
8
Q
What is the management of Menopausal Symptoms?
A
- Lifestyle management
- Hormone Replacement Therapy (HRT) management
- Non-HRT management
9
Q
What are the methods of lifestyle management in menopause?
A
- Hot flushes: regular exercise, weight loss and reduce stress
- Sleep disturbance: avoiding late evening exercise and maintaining good sleep hygiene
- Mood: sleep, regular exercise and relaxation
- Cognitive symptoms: regular exercise and good sleep hygiene
- Smoking cessation, reduction in alcohol and coffee intake
- Mediterranean diet is recommended
10
Q
What are the medications for Hormone Replacement Therapy?
A
-
Oral/Transdermal Combined HRT or Mirena IUS
- If woman has a uterus, important to avoid unopposed oestrogens and it increase endometrial cancer risk
- Oestrogen alone given either orally or in transdermal patch if woman does not have uterus
- Tibolone: own class of HRT
- Vaginal oestrogen: vaginal pessaries or cream to help with vaginal and urinary symptoms
11
Q
What are the practicalities of administering HRT?
A
- Sequential HRT: started within 12 months of last period to minimise risk irregular bleeding patterns
- Continuous Combined HRT: not had a period for 12 months. Women can experience irregular bleeding in first 3 months of treatment
12
Q
What are the benefits of HRT?
A
- Most effective treatment for hot flushes and low mood
- Decline in sexual function is due to lack of oestrogen and HRT which can improve sexual desire and reduce vaginal dryness and pain with sex
- Prevents osteoporosis thereby reducing risk of falls associated fractures
- HRT reduces some urinary symptoms and risk of urine infections particularly when used topical vaginal preparations
13
Q
What are contraindications for HRT treatment?
A
- Current or past breast cancer
- Any oestrogen-sensitive cancer
- Undiagnosed vaginal bleeding
- Untreated endometrial hyperplasia
14
Q
What are risks of HRT treatment?
A
- 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.
15
Q
What are non-HRT methods of management in Menopause?
A
- Vasomotor symptoms: fluoxetine, citalopram or venlafaxine
- Vaginal dryness: vaginal lubricant or moisturiser
- Psychological symptoms: self-help groups, cognitive behaviour therapy or antidepressants
- Urogenital symptoms: vaginal oestrogen if suffering from urogenital atrophy. Appropriate if taking HRT or not. Moisturises and lubricants can be offered as well for vaginal dryness
- Alternative therapy: occupressure, acupuncture, reflexology or homeopathy. Role of aromatherapy is not proven beneficial
- Androgen (testosterone) therapy: used for fall in libido or sex drive. Also used for loss of energy and concentration
16
Q
What are important details in regards to stopping treatment of Menopause?
A
- 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.
- Referral to secondary care if treatment has been ineffective, if there are ongoing side effects or if there is unexplained bleeding.
17
Q
What is Post-menopausal bleeding?
A
Vaginal bleeding occurring after twelve months of amenorrhoea in women at the age where menopause can be expected.
- Can occur in younger women however who have experienced premature ovarian failure or premature menopause. Usually benign but endometrial malignancy should be ruled out
