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Module 203 Reproduction & endocrinology > T3 L7 Menopause and HRT > Flashcards

T3 L7 Menopause and HRT Flashcards

1
Q

What is menopause?

A

Permanent cessation of menses following loss of ovarian activity

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2
Q

How much of a female’s lifespan is spent in menopause?

A

1/3 to 1/2

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3
Q

What is peri-menopause?

A

Transition from reproductive cycles to post menopause

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4
Q

How long before menopause do changes in the reproductive cycle start occurring?

A

10 years

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5
Q

What is the typical age for the start of menopause?

A

45 - 50 years

Median age is 47.5 years

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6
Q

What is the mean duration of peri-menopause?

A

3.8 years

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7
Q

What happens during peri-menopause?

A 
Few ova remain and are less responsive to hormones
Irregular menstrual cycles
Occasional heavy bleeding
Hot flushes
Nervousness, irritability
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8
Q

What are the primary symptoms of menopause?

A

Menstrual cycle changes - oligomenorrhoea, amenorrhoea
Vasomotor symptoms - hot flushes, night sweats
Vaginal dryness

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9
Q

What are the secondary symptoms of menopause?

A

Urinary stress / urge incontinence
Cystitis like symptoms
Musculoskeletal pains - joint aches, osteoporosis
Dry skin, hair thinning, nail changes
Psychophysiological changes - decreased concentration, depression, irritability, insomnia, fatigue
Decreased libido

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10
Q

What are the 4 groups of menopausal symptoms identified in the 2012 British prospective cohort study?

A

Psychological
Somatic
Vasomotor
Sexual discomfort

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11
Q

In HRT, what is oestrogen required for?

A

Treatment of symptoms

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12
Q

In HRT, what are progestogens required for?

A

Preventing endometrial cancer

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13
Q

What are the 3 alternatives to HRT?

A

Drugs for osteoporosis
Drugs to reduce vasomotor symptoms
Complementary and alternative therapies

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14
Q

What drugs are used for osteoporosis?

A

Bisphosphonates

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15
Q

What drugs are used to reduce vasomotor symptoms?

A

Progesterone
SERMs - raloxifene
Beta blockers
Clonidine

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16
Q

What are some complementary and alternative therapies?

A 
Phyto-oestrogens
Herbalism - Black cohost, St John's Wort, Gingseng, oil of evening primrose
Progesterone cream
Homeopathy
Acupuncture
Reflexology
17
Q

What are the options for route in HRT?

A 
Oral
Patches
Implants
Vaginal rings
Transdermal gel
Nasal
18
Q

What HRT is given when there is no uterus?

A

Just given oestrogen
1mg Oestradiol taken continuously
Too low a dose to act as a contraception

19
Q

What HRT is given when there is a uterus?

A

Combined HRT
Oestradiol every day
Norgestrol (oestrogen and progestogen) for 11 days
Take packet one after the other or have 7 days break

20
Q

What are the absolute contraindications to HRT?

A 
Pregnancy
Active venous thromboembolism 
Severe active liver disease
Endometrial carcinoma with recurrence
Breast carcinoma with recurrence
21
Q

What are the relative contraindications to HRT?

A 
Abnormal bleeding
Breast lump
Previous endometrial cancer
Previous breast cancer
Strong family history of breast cancer
Family history of thromboembolism
22
Q

What are the side effects of HRT?

A 
Tender or painful breasts
Fluid retention leading to bloating and weight gain
Nausea
Headaches
Leg cramps
Mood swings
Acne
Backache
Lower abdominal ache
Bleeding
Stomach upset (indigestion)
23
Q

What are the short term benefits of HRT?

A

Reduces vasomotor symptoms

Improves psychological symptoms

24
Q

What are the long term benefits of HRT?

A 
Maintains bone mass and reduces risk of fractures
Reduces urogenital problems
Improves skin
Reduces risk of bowel cancer
May improve balance and reduce falls
May reduce tooth loss
May protect against arthritis
25
Q

What are the risks of HRT?

A

Endometrial cancer if unopposed oestrogen is used
Breast cancer
Cardiovascular disease
Venous thromboembolic disease

26
Q

How does endometrial cancer first present?

A

Post-menopausal bleeding

27
Q

What are the risk factors for endometrial cancer?

A 
Obesity
Unopposed HRT
Nulliparity
Late menopause
Diabetes
Family history of breast, colon and ovarian cancer
28
Q

What investigations are done in endometrial cancer?

A

Trans vaginal ultrasound scan to measure endometrial thickness

29
Q

How is endometrial cancer diagnosed?

A

Endometrial biopsy

30
Q

What is the treatment for endometrial cancer?

A

Hysterectomy and oophorectomy

Radiotherapy

31
Q

How is HRT different to COCP?

A

Oestradiol is natural
Lower dose
HRT doesn’t suppress FSH and LH to same degree as COCP
Doesn’t stop ovulation

32
Q

What is the advice regarding HRT?

A

Little or no risk of CVD with HRT below age of 60
There is a risk of thrombosis with oral HRT - avoid by using gels / implants
Combined HRT has a risk of breast cancer

Module 203 Reproduction & endocrinology (52 decks)

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