Problems Around the Menopause Flashcards
what causes menopause?
due to a loss of ovarian follicular activity leading to a fall in oestrogen levels below that needed for endometrial stimulation
premature menopause definition?
menopause <45
how is premature menopause confirmed?
2 measurements of FSH and LH at least 2 weeks apart
physical effects of meopause?
vasomotor (hot flushes) joint aches and pains dry and itchy skin hair changes vaginal dryness and soreness (dyspareunia) recurrent UTI urogenital prolapse osteoporosis cardiovascular disease dementia
psychological features of menopause?
labile mood anxiety tearfulness loss of concentration poor memory loss of libido
first step in management of menopause?
manage symptoms conservatively (lifestyle modification, increase exercise etc)
what is the main medical management for troublesome menopause symptoms?
hormone replacement therapy
can be given via pathes, gels, tablets or implants
what is the main hormone in HRT and how is it given?
oestrogen
can be given alone if the women has no uterus or in combination with progesterone in others
best method of HRT in women with risk of VTE?
oestrogen patches
transdermal avoids first pass metabolism reducing impact on liver
HRT can be given in what cycles?
continuous combined HRT (have to be post-menopausa)
cyclical combined HRT (for perimenopausal women who still get periods)
how is cyclical combined HRT given?
oestrogen tablets each day of the month and a progesterone tablet on the last 14 days of the month
side effects of continuous combined HRT?
can have erratic bleeding in first 3-6 months
what 3rd hormone can be added to help reduced libido?
testosterone
what non-hormonal treatment can be used for menopausal treatment?
SSRI
CBT can help manage psychological effects
when might SSRI be used instead of HRT?
women with history of breast cancer
HRT much more effective
how soon is improvement seen after starting HRT?
4-6 weeks
when should women be reviewed after starting HRT?
3 months
why do women with premature ovarian failure have to take HRT until age 50?
protect bone health
how can cardio risk be reduced in premature menopause?
sex steroid hormone replacement
will also prevent osteoporosis and improve cognitive function
contraception around the menopause?
contraception should continue for 2 years after the last menstrual period in women under 50
should continue for 1 year in women > 50
side effects of HRT?
oestrogen related side effects (breast enlargement, leg cramps, dyspepsia, fluid retention, nausea, headaches)
progesterone related side effects (similar to pre-menstrual symptoms - fluid retention, breast tenderness, headaches, acne, mood swings, depression, irritability, constipation, increased appetite)
risks associated with HRT?
breast cancer
VTE, PE and stroke
endometrial cancer
risk of breast cancer in HRT?
only small increase
risk of VTE in HRT?
risk doubles (esp in first year)
risk without HRT is low anyway so double risk still isnt that big
causes bigger risk in women with other risk factors too
lower risk than COCP
how can risk of endometrial cancer be reduced in HRT?
adding progesterone
risk is higher if oestrogen only
absolute contraindications to HRT?
suspected pregnancy breast cancer endometrial cancer acute liver disease uncontrolled hypertension known VTE known thrombophilia osteosclerosis
relative contraindications to HRT?
uninvestigated abnormal bleeding large uterine fibroids past history of benign breast disease unconfirmed personal history or strong family history of VTE chronic stable liver disease migraine with aura
