The menopause and post-reproductive health Flashcards
What is the menopause?
The permanent cessation of menstruation resulting from loss of ovarian follicular activity.
What is the average age of menopause?
51 years
How can you tell is someone is in the menopause?
After 12 months of amenorrhoea
What is the perimenopause?
The time beginning with the first features of the approaching menopause, such as vasomotor symptoms and menstrual irregularity, and ends 12 months after the LMP.
What is premature menopause?
Menopause occurring before the age of 40. In most women, no cause is found.
What is post-menopausal bleeding?
Vaginal bleeding occurring at least 12 months after the LMP.
What are the causes of post-menopausal bleeding?
Endometrial carcinoma Endometrial hyperplasia Cervical carcinoma Atrophic vaginitis Cervicitis Ovarian carcinoma Cervical polyps
How would you investigate post-menopausal bleeding?
All women should undergo a bimanual and speculum examination and a cervical smear. TVS measures endometrial thickness and gives info on other pelvic pathologies.
What would indicate an increased risk of malignancy or other pathology on TVS in post-menopausal bleeding?
A thickened endometrium or cavity filled with fluid.
What are the different systems effected by menopause?
Vasomotor, urogenital, sexual problems and osteoporosis
What are the vasomotor symptoms of menopause?
Hot flushes and night sweats are the most common symptoms.
What are the complications of night sweats?
They can cause sleep disturbances leading to tiredness and irritability.
When do night sweats start?
They may begin before periods stop and usually are present for less than 5 years. However, in some women they may continue
What are the genital problems associated with menopause?
Oestrogen deficiency can cause vaginal atrophy and urinary problems.
What are the complications of vaginal atrophy?
It can be extremely uncomfortable and can result in dyspareunia, cessation of sexual activity, itching, burning and dryness.
What urinary symptoms are associated with menopause?
Frequency, urgency, nocturia, incontinence and recurrent infection.
What sexual problems are associated with menopause?
Decreased interest in sex, loss of sexual desire, loss of sexual arousal, problems with orgasm and sexual pain.
What are the two main features of bone strength?
Bone density and bone quality
What is bone density?
It is expressed as grams of mineral per area or volume and, in any given individual, is determined by peak bone mass and amount of bone loss
What is bone quality?
Architecture, turnover, damage accumulation (microfractures) and mineralization
What is the T score?
The number of standard deviations by which a particular bone differs from the young normal mean.
Where are the most common sites for osteoporotic fractures?
The wrist or Colles’ fracture, the hip and the spine.
What are the risk factors for the development of osteoporosis?
Parental history of fracture (particularly hip), early menopause, chronic use of corticosteroids (oral and possibly inhaled), prolonged immobilisation and prior fracture
What environmental risk factors are there for osteoporosis?
Cigarette smoking
Alcohol abuse
Low calcium intake
Sedentary lifestyle
What are the diseases that increase the risk of osteoporosis?
Rheumatoid arthritis Neuromuscular disease Chronic liver disease Malabsorption syndromes Hyperparathyroidism Hyperthyroidism Hypogonadism
How is FSH used to investigate menopause?
Increased levels suggest fewer oocytes remain in the ovaries. It is useful in women with premature menopause. They are measured on days 2-5 of the cycle
How is anti-Mullerian hormone used to investigate menopause?
AMH gives a direct measurement of ovarian reserve, low levels being consistent with ovarian failure.
What HRT is given to women?
HRT consists of oestrogen alone in women who have had a hysterectomy, but is combined with a progestogen in those who have not.
How are the progestogens given in HRT?
Cyclically or continuously with the oestrogen. They can be delivered orally, transdermally or directly into the uterus (IUS).
How are the oestrogens given in HRT?
It can be delivered orally, transdermally (patch or gel) or subcutaneously (implant). Topical oestrogens are given vaginally
What are some examples of oestrogens used in HRT?
They are natural oestrogens: oestrodiol, oestrone and oestriol.
What are some examples of progestogens in HRT?
Leonorgestrel (mirena) or norethisterone.
What is the benefit of using the mirena IUS?
It provides a solution to the problem of contraception in the perimenopause and is also the only way in which a ‘no bleed’ HRT regimen can be achieved in perimenopausal women.
What is tibolone?
A synthetic steroid compound that is inert but is converted in vivo to metabolites with oestrogenic, progestogenic and androgenic actions.
When is tibolone used?
In post-menopausal women who desire amenorrhoea and treats vasomotor, psychological and libido problems. It also conserves bone mass.
What are the benefits of oestrogen-based HRT?
It is an effective treatment for hot flushes, usually within 4 weeks. It may also help urogenital problems. It reduces the risk of bone problems.
How does HRT affect cancer risks?
Increased risk: breast (not if oestrogen only) and endometrial. Also increases risk of VTE and gallbladder disease
Decreased risk: colon
How long do women take HRT for?
Treatment is continued for up to 5 years and then stopped to evaluate whether symptoms recur with sufficient severity to warrant continuation
