Week 6 - C - Menopasue - Definition, Symptoms, Treatment (Benefits and Risks) Flashcards
What age does menopasuse occur on average?
What is menopasue defined as?
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
What is the menopause also known as?
What is early, premature and late menopause defined as?
Climacteric - the period of life of waning fertility leading to the last period (the menopause)
Early menopause - 54 years of age
What hormone is menopause due to?
How long does menopause last on average?
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
What effects does oestrogen have on the rest of the body in females?
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
As we know the effects that oestrogen has on the body, during menopause when oestrogen levels drop, what symptoms can this cause?
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
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?
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
What are the physical symptoms of menopause?
Physical symptoms
- Hot flushes
- Sweaty
- Palpitations
- Insomnia
- Joint aches
- Headaches
- More likely to gain weight around abdomen, hips and thighs
What are the psychological symptoms of menopause?
Moody
Agitated/irritable
Anxiety/low mood
Difficulty concentrating and forgetfulness
What are the sexual symptoms of menopause?
Vaginal dryness and decreased libido
Now, run through the physical, psychological and sexual symptoms of menopause
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
Hot flushes affects
60-80% of menopausal women
20% have severe symptoms
How long do they tend to last and how many yea
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
What are the later symptoms of menopasue?
Dry hair and skin
Frequent UTIs
Atrophy and genitalia and breast tissue
Incontinence
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
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
Your GP can usually confirm whether you are menopausal based on your symptoms, but a blood test to measure your hormone level
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
What does the blood test measure?
When should you not be offered a blood test to test if you are in menopause? (apart form
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
What is the conservative treatment of the menopasual symptoms?
Weight loss
Diet
Reduce caffeine
Exercise
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)
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
If medication doesn’t work to treat the menorrhagia, what can be attempted?
Ca try endometrial ablation/resection
Hysterectomy if this fails
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?
Pre-menopausal - less than 16mm thick
Post-menopasual - less than 4mm thick
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?
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
What are contraindications to HRT?
Oestrogen dependent cancers
Past pulmonary embolism
Undiagnosed PV bleeding
Breast cancer
What are the benefits of HRT?
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
What non hormonal drug may be given to treat the hot flushes experienced in menopasue?
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
