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GOSH > The Menopause > Flashcards

The Menopause Flashcards

1
Q

What is the median age for the menopause?

A

51

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2
Q

When do we say the woman has gone through the menopause?

A

It is a retrospective diagnosis because the woman has to have been AMENORRHOEIC for 12 months before we stay she has been through menopause

OR
-6months no periods with high levels of FHS and LH >30 2 separate occasions 6 weeks apart

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3
Q

What is the menopause?

A

Ovarian failure

No more remaining oocytes

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4
Q

Pathophysiology of menopause?

A

Ovaries (follicles) no longer produce oestrogen> low oestrogen>+ve feedback loop>increased LH/FSH

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5
Q

What levels of FSH can be expected during the menopause?

A

FSH >30U/L - not a sensitive test because they fluctuate a lot in peri-menopausal period
FSH permanently elevated after menopause

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6
Q

What hormone is a better measure of ovarian reserve than FSH?

A

Anti-mullerian hormone

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7
Q

What are some symptoms of the menopause?

A

EARLY

  • VASOMOTOR (hot flushes - uncomfortable, troublesome at night and might have nausea, sweatiness and palpations)
  • PERIOD changes (Irregular periods. If persistent or recurs after 12m amenorrhoea consider ix
  • mood changes
  • lethargy
  • insomnia
  • loss of collagen (joint/muscle aches, skin/hair changes)

MEDIUM

  • ATROPHY - may cause PCB, discomfort and itch and increased infections
  • BLADDER (frem, urgency, UTIs)

LONG

  • osteoporosis
  • cardiovascular disease
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8
Q

How do you manage menopausal symptoms

A
  1. Education on normal/healthy ageing process
  2. Lifestyle changes
    -regular swimming/running to support bone
    -lighter clothing
    -reducing stress
    reduce caffeine and smoking (depletes oestrogen supplies)
  3. Hormone replacement therapy (HRT)
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9
Q

What is the basis of HRT?

How long is it normally given for?

A

-Oestrogen replacement to ease symptoms
Usually given orally but can get transdermal patches/intrauterine/vaginal

-2-3 years

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10
Q

What are some side effects and risks associated with HRT?

A

HRT
-Nausea and vomiting
-Increased risk of breast cancer (especially with coil version>dont give if risk factors)
(progesterone makes mammography difficult)
-Increased risk of endometrial cancer (only for sequential combined, NOT continuous combined)
-VTE
-Uterine bleeding
-Breast tenderness

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11
Q

What else can be used to specifically treat vasomotor symptoms?

A

Clonidine (acts indirectly on hypothalamus)

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12
Q

What form of HRT should be given to women who have not yet been amenorrhoeic for 12 months?

A

Sequential COMBINED CYCLICAL HRT

  • Helps cause predictable withdrawal bleeding
  • mimics normal hormones (progesterone at end)
  • can get LONG CYCLICAL which offers withdrawal bleed every 3 months instead of 1 month

-if >54 years can just give COMBINED CONTINUOUS (will be post menopausal)

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13
Q

If a woman has been amenorrhoeic for 12 months what will she receive?

A

CONTINUOUS COMBINED HRT (estrogen and progesterone-no bleed)

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14
Q

What type of HRT would a woman with a previous hx of cancers (e.g. endometrial) be offered?

A

-Combined (need protective effect of progesterone)

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15
Q

What sort of treatment could be given if the atrophic, or urinary symptoms predominate?

A

An oestrogen ring or pessary for localised release

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16
Q

What is primary ovarian insufficiency?

A

Menopause <40 years

-HRT risks (cancer/VTE) dont apply to these patients as its just replacing normal levels of oestrogen, not giving more

17
Q

What is tibolone?

What patients is it good for?

A
  • Tibolone is synthetic steroid
  • Combined eostrogen, progesterone and androgen
  • Therefore no withdrawal bleed
  • Good for patients complaining of low libido
18
Q

Benefits of HRT?

A 
Improve symptoms (hot flush) 
Improve mood/sleep 
Improve urinary symptoms 
Help bones (reduce fractures)
Reduce colorectal cancer
19
Q

What HRT do you give for women with VTE risk factors?

A
  • If VTE risk factors don’t give oral (it passes through liver and affects clouting)
  • GIVE TRANSDERMAL
20
Q

What HRT is good for women with absent uterus?

A

Oestrogen only HRT (no need for protective progesterone)

21
Q

When would you give continuous HRT

A
  • Continuous if have used cyclical for >1yr -OR >1yr since LMP
  • OR at least 2 yrs since LMP if premature menopause

GOSH (29 decks)

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