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Reproduction > Week 6- Menopause > Flashcards

Week 6- Menopause Flashcards

1
Q

What is the average age of menopause?

A

51 years.

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2
Q

When is it called early menopause?

A

<45 years

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3
Q

When is it called premature menopause?

A

<40 years

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4
Q

When is it called late menopause?

A

>54 years.

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5
Q

Why do you not get a period in/after menopause?

A

Once the follicles have all run out there is nothing to produce oestrogen anymore, therefore you don’t get a period.

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6
Q

What effects does oestrogen have on the body?

A

Secondary sexual characteristics Hair distribution, body shape and fat distribution Effect on collagen Bone growth Proliferates endometrium

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7
Q

What are the symptoms of menopause?

A

Hot flushes Amenorrhoea (12 months of amenorrhoea is necessary for diagnosis) or irregular periods Mood swings Night sweats Palpitations Joint aches Insomnia

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8
Q

At what age can you be diagnosed with menopause on symptoms along?

A

at the age of 45.

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9
Q

How else can you diagnose menopause in women younger than 45?

A

FSH (not allowed to do this in women >45) two occasions where it is >30

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10
Q

Why does FSH increase in women with menopause?

A

The FSH tries to get the follicles to mature, however there aren’t any, so levels go up in an attempt to counteract this.

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11
Q

Does a normal FSH mean she is not going through menopause?

A

No, it doesn’t exclude this.

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12
Q

In what other situations will FSH be raised?

A

Raised prior to ovulation Raised when stopping combined oral contraceptive or depo. Raised with breastfeeding and certain meds (SSRIs)

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13
Q

How long will the hot flushes last?

A

2-3 years. They occur in 3-5 minute intervals.

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14
Q

How can you conservatively manage hot flushes?

A

Avoiding sudden temperature change Avoiding spicy foods Avoiding caffeine and alcohol Reduce stress

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15
Q

What psychological symptoms can you get in menopause? How can you treat these?

A

Mood swings Irritability Anxiety Difficulty concentrating Forgetfulness HRT is the best option to treat these. However CBT can be of some use.

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16
Q

What sexual symptoms can you get with menopause?

A

Vaginal dryness Loss of libido- ovaries start to produce some testosterone.

17
Q

What later symptoms may someone suffering from menopause have?

A

Recurrent UTI’s Frequency Dysuria Incontinence Dry skin and hair Atrophy of breasts and genitals

18
Q

Why do you get intermenstrual bleeding and post menopausal bleeding in menopause?

A

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.

19
Q

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?

A

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.

20
Q

What conservative management can aid with menopause?

A

Weight loss Diet Exercise Lifestyle Caffeine

21
Q

What pills can you take to help with menorrhagia?

A

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.

22
Q

Is osteoporosis associated with menopause?

A

Yes- menopause accelerates bone loss.

23
Q

What does hormone replacement therapy consist of?

A

Can be both oestrogen and progesterone or just oestrogen (in little number of cases).

24
Q

When would you give just continuous oestrogen only HRT? What forms does it come in?

A

Women without a uterus (If you’ve had a hysterectomy) or a mirena coil (as this already releases progesterone). Can be oral or transdermal.

25
Q

Why do you give oestrogen and progesterone when you are just deficient in oestrogen when going through menopause?

A

Progesterone protects against endometrial hyperplasia and cancer.

26
Q

What is the most effective treatment for vasomotor symptoms e.g. hot flushes, night sweats?

A

Oestrogen.

27
Q

When is HRT given?

A

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.

28
Q

If a women has breakthrough bleeding 6 months into HRT therapy, what is the management?

A

Pelvic ultrasound and endometrial biopsy to reassess.

29
Q

What mode of delivery of HRT is preferred in women with high VTE risk?

A

Transdermal patches rather than oral.

30
Q

What is the treatment for perimenopausal women?

A

Sequential combined HRT.

31
Q

What is the treatment for postmenopausal women?

A

Continuous combined HRT.

32
Q

If the women is over the age of 50, how long does she need to use additional contraception for?

A

A year from the last period.

33
Q

If the women is aged 40-49, how long does she need to use contraception for?

A

2 years from last period.

34
Q

HELPFUL PIC

A
35
Q

What is HRT protective against?

A

Osteoporotic fractures

Bowel cancer

Possible alzheimers and parkinsons

HRT<10 years- fewer CVS risks.

36
Q

What are the risks of HRT?

A

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

37
Q

When is HRT contraindicated?

A

Cardiovascular disease

Liver disease

Lupus

Previous breast, endometrial or ovarian cancer

38
Q

What are some non- HRT alternatives?

A

Clonidine- alpha 2 agonist- good for vasomotor symptoms

Regelle- vaginal moisteriser

Yes and Sylk- vaginal lubricants

SSRI’s (think they increase oestrogen).

Reproduction (34 decks)

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