Week 6- Menopause Flashcards
What is the average age of menopause?
51 years.
When is it called early menopause?
<45 years
When is it called premature menopause?
<40 years
When is it called late menopause?
>54 years.
Why do you not get a period in/after menopause?
Once the follicles have all run out there is nothing to produce oestrogen anymore, therefore you don’t get a period.
What effects does oestrogen have on the body?
Secondary sexual characteristics Hair distribution, body shape and fat distribution Effect on collagen Bone growth Proliferates endometrium
What are the symptoms of menopause?
Hot flushes Amenorrhoea (12 months of amenorrhoea is necessary for diagnosis) or irregular periods Mood swings Night sweats Palpitations Joint aches Insomnia
At what age can you be diagnosed with menopause on symptoms along?
at the age of 45.
How else can you diagnose menopause in women younger than 45?
FSH (not allowed to do this in women >45) two occasions where it is >30
Why does FSH increase in women with menopause?
The FSH tries to get the follicles to mature, however there aren’t any, so levels go up in an attempt to counteract this.
Does a normal FSH mean she is not going through menopause?
No, it doesn’t exclude this.
In what other situations will FSH be raised?
Raised prior to ovulation Raised when stopping combined oral contraceptive or depo. Raised with breastfeeding and certain meds (SSRIs)
How long will the hot flushes last?
2-3 years. They occur in 3-5 minute intervals.
How can you conservatively manage hot flushes?
Avoiding sudden temperature change Avoiding spicy foods Avoiding caffeine and alcohol Reduce stress
What psychological symptoms can you get in menopause? How can you treat these?
Mood swings Irritability Anxiety Difficulty concentrating Forgetfulness HRT is the best option to treat these. However CBT can be of some use.
What sexual symptoms can you get with menopause?
Vaginal dryness Loss of libido- ovaries start to produce some testosterone.
What later symptoms may someone suffering from menopause have?
Recurrent UTI’s Frequency Dysuria Incontinence Dry skin and hair Atrophy of breasts and genitals
Why do you get intermenstrual bleeding and post menopausal bleeding in menopause?
Sometimes the FSH manages to stimulate an egg to be released, but because its taken it so much effort to do it the period you get is very heavy.
When would you be concerned about post menopausal bleeding? In a 54 year old? In a 70 year old or in a 90 year old?
In a 54 year old women its likely to be the ovaries finally responding to the FSH build up. In a 70 year old its likely to be malignancy In a 90 year old their tissues are more prone to damage so you are less worried.
What conservative management can aid with menopause?
Weight loss Diet Exercise Lifestyle Caffeine
What pills can you take to help with menorrhagia?
Mirena coil is helpful Start with mefenamic acid or tranexamic acid. Could also give an NSAID- reduces blood supply to womb and helps with pain Or an anti-fibrinolytic- Stops your clots from breaking down so bleed less. Progesterones- stop the bleeding. Endometrial ablation if that doesn’t work. Then hysterectomy if that doesn’t work.
Is osteoporosis associated with menopause?
Yes- menopause accelerates bone loss.
What does hormone replacement therapy consist of?
Can be both oestrogen and progesterone or just oestrogen (in little number of cases).
When would you give just continuous oestrogen only HRT? What forms does it come in?
Women without a uterus (If you’ve had a hysterectomy) or a mirena coil (as this already releases progesterone). Can be oral or transdermal.
Why do you give oestrogen and progesterone when you are just deficient in oestrogen when going through menopause?
Progesterone protects against endometrial hyperplasia and cancer.
What is the most effective treatment for vasomotor symptoms e.g. hot flushes, night sweats?
Oestrogen.
When is HRT given?
Can be given to women going through the menopause or post menopausal. Post menopausal is defined as >12 months amenorrhoeic. Perimenopausal is amenorrhoea (less than 12 months) and symptoms.
If a women has breakthrough bleeding 6 months into HRT therapy, what is the management?
Pelvic ultrasound and endometrial biopsy to reassess.
What mode of delivery of HRT is preferred in women with high VTE risk?
Transdermal patches rather than oral.
What is the treatment for perimenopausal women?
Sequential combined HRT.
What is the treatment for postmenopausal women?
Continuous combined HRT.
If the women is over the age of 50, how long does she need to use additional contraception for?
A year from the last period.
If the women is aged 40-49, how long does she need to use contraception for?
2 years from last period.
HELPFUL PIC
What is HRT protective against?
Osteoporotic fractures
Bowel cancer
Possible alzheimers and parkinsons
HRT<10 years- fewer CVS risks.
What are the risks of HRT?
VTE- if a women has a history of this she needs to be seen by a menopause specialist.
Breast cancer- due to the oestrogen and progesterone.
Gallbladder disease
HRT>20 years after the menopause increases harm.
Cerebrovascular accident
When is HRT contraindicated?
Cardiovascular disease
Liver disease
Lupus
Previous breast, endometrial or ovarian cancer
What are some non- HRT alternatives?
Clonidine- alpha 2 agonist- good for vasomotor symptoms
Regelle- vaginal moisteriser
Yes and Sylk- vaginal lubricants
SSRI’s (think they increase oestrogen).
