Week 6 - C - Menopasue - Definition, Symptoms, Treatment (Benefits and Risks)

Question 1

What age does menopasuse occur on average?

What is menopasue defined as?

Answer 1

The average age of menopause is 51 years

Menopause is defined as when a women no longer has periods and is no longer able to get pregnant naturally

Menopasue by many medical professionals is often defined as a woman who has not had any vaginal bleeding for 12 months

Question 2

What is the menopause also known as?

What is early, premature and late menopause defined as?

Answer 2

Climacteric - the period of life of waning fertility leading to the last period (the menopause)

Early menopause - 54 years of age

Question 3

What hormone is menopause due to?

How long does menopause last on average?

Answer 3

Menopause occurs dye to decreasing oestrogen levels
It happens because as ageing occurs, the ovaries stop producing as much of the hormone oestrogen each month and stop releasing eggs

Menopause lasts 4 years on average - HRT usually used during these 4 years to control symtpoms

Menopause can last way longer however

Question 4

What effects does oestrogen have on the rest of the body in females?

Answer 4

Oestrogen
Secondary sexual characteristics - eg breast enlargement

Hair distribution, body shape and fat distribution

Has an effect on collagen

Bone growth

Also causes proliferation of the endometrium

Question 5

As we know the effects that oestrogen has on the body, during menopause when oestrogen levels drop, what symptoms can this cause?

Answer 5

the common symptoms of the menopause are associated with a decrease in the body’s production of oestrogen. Oestrogen lack can affect many parts of the body, including the brain, causing changes in emotional well-being, and the skin, influencing its elasticity and thickness.

• Atrophy of oestrgoen dependent tissues eg genitalia & breasts - can cause atrophic vaginitis and menorrhagia
• Osteoporosis
• Mood irritabiliy
• Hot flushes, sweating, palpitations

Question 6

FSH and LH are released in a pulsatile fashion, which hormone causes their release?
When are these two hormones raised during the menstrual cycle?

What drug can cause an increase in these two hormones also?

Answer 6

Gonadotrophin releasing hormone (GnRH) causes release of FSH and LH in a pulsatile fashion

FSH and LH are raised just prior to ovulation in the menstrual cycle
They SSRI (Selective serotonin reuptake inhibitors) can cause an increase in the levels of these hormones

Question 7

What are the physical symptoms of menopause?

Answer 7

Physical symptoms

• Hot flushes
• Sweaty
• Palpitations
• Insomnia
• Joint aches
• Headaches
• More likely to gain weight around abdomen, hips and thighs

Question 8

What are the psychological symptoms of menopause?

Answer 8

Moody

Agitated/irritable

Anxiety/low mood

Difficulty concentrating and forgetfulness

Question 9

What are the sexual symptoms of menopause?

Answer 9

Vaginal dryness and decreased libido

Question 10

Now, run through the physical, psychological and sexual symptoms of menopause

Answer 10

Physical

Hot flushes, sweaty, palpitations, insomnia, joint aches, headaches, weigh gain (oestrogen usually helps with fat distribution, in its absence fat gathering around abdomen, hips and thighs)

Psychological

Moody, agitated/irritable, anxie

Question 11

Hot flushes affects

60-80% of menopausal women

20% have severe symptoms

How long do they tend to last and how many yea

Answer 11

They tend to last 2-3 minutes on average and usually last around 2 years on average

They can continue for 15 years in 10% of females

Question 12

What are the later symptoms of menopasue?

Answer 12

Dry hair and skin

Frequent UTIs

Atrophy and genitalia and breast tissue

Incontinence

Question 13

If menopausal symptoms are affecting your day‑to‑day life you should see your GP. Your GP should be able to tell if you are i

Answer 13

Perimenopause, or menopause transition, begins several years before menopause. It’s the time when the ovaries gradually begin to make less estrogen.

Usually this is noticed due to irregular bleeds, intermenstrual bleeding - dysfunctional uteirne bl

Question 14

Your GP can usually confirm whether you are menopausal based on your symptoms, but a blood test to measure your hormone level

Answer 14

Blood tests if:
Between 40 and 45 and your GP suspects menopasual symptoms including changes in your menstrual cycle
Below 40 and your GP suspects you are in menopause

Question 15

What does the blood test measure?

When should you not be offered a blood test to test if you are in menopause? (apart form

Answer 15

The blood test measures the level of FSH (oestrogen usually has a negative feedback effect on this hormone) - 2FSH levels >30IU/l 1 month apart suggests menopause

The test should not be carried out if the patient is on a combined pill or high dose

Question 16

What is the conservative treatment of the menopasual symptoms?

Answer 16

Weight loss

Diet

Reduce caffeine

Exercise

Question 17

Due to the atrophy of oestrogen dependent tissues, bleeding may be a major problem during the perimenopausal and menopasual period - menorrhagia

WHat is the treatment guidlines for menorrhagia? (1st, 2nd and 3rd line)

Answer 17

Treatment

1st line - IUS (Mirena coil intrauterine system)

2nd line - Tanexamic acid (anti-fibrinolytic), NSAIDs (anti-prostoglandin eg Mefanamic acid - helps with pain mainly), or combined oral pill

3rd line - oral progesterone

Question 18

If medication doesn’t work to treat the menorrhagia, what can be attempted?

Answer 18

Ca try endometrial ablation/resection

Hysterectomy if this fails

Question 19

Also the atrophy affects the thickness of the endometrium

For endometrial cancer purposes, what is the endometrial thickness of TVUS meant to be in pre and post menopasual women?

Answer 19

Pre-menopausal - less than 16mm thick

Post-menopasual - less than 4mm thick

Question 20

Hormone replacement therapy may help treat quite a number of the problems caused by the oestrgoen deficiency ie hot flushes and atrophic vaginitis

When is oestrogen only replacement therapy given?
When is combined HRT given?
When is topical oestrogen given?

Answer 20

Oestrogen only HRT is given if the patient does not have a womb - has had a hysterectomy
Combined HRT - given if the patient has a womb (Oestrogen only can damage the womb lining)

Topical oestrogen can be given for patients with atrophic vaginitis

Question 21

What are contraindications to HRT?

Answer 21

Oestrogen dependent cancers
Past pulmonary embolism
Undiagnosed PV bleeding

Breast cancer

Question 22

What are the benefits of HRT?

Answer 22

Benefits

• Symptoms control
• Reduced osteoporosis
• Reduced bowel cancer
• Maybe protective against Alzheimer&Parkinson’s

Risks

• VTE
• Breast cancer
• Gallbladder disease
• HRT use >20 years increases risk of harm

Question 23

What non hormonal drug may be given to treat the hot flushes experienced in menopasue?

Answer 23

Can opt to give clonidiine - t is classified as a centrally acting α2 adrenergic agonist and imidazoline receptor agonist

usually SSRIs (for mood symptoms) or clonidine (for the hot flushes) given if the patient doesn’t want hormonal therapy