Women's Health : Menopause Flashcards
How is menopause defined?
Menopause is defined retrospectively as the point 12 months after a woman’s last natural menstrual period.
What is perimenopause?
physiological changes and associated signs and symptoms during the period of time before the menopause
What is premature ovarian insufficiency?
Menopause that occurs before 40 years old.
What is the average age of menopause?
51 years old, typically occurring between 40 and 60 years.
What causes the hormonal changes during menopause?
- Declining reserves of oocytes and associated follicles leads to reduced oestrogen production in response to FSH and LH stimulation. 2. Therefore serum LH and FSH rise in response (lack of negative feedback). 3. Eventually insufficient oestrogen means the LH surge and subsequent ovulation do not occur, leading to anovulatory cycles
Why do anovulatory cycles occur in menopause?
Low circulating progesterone due to anovulation leads to unpredictable breakthrough bleeding.
What physiological factors contribute to hot flushes?
The physiology of hot flushes is multifactorial and not fully understood, but is thought to be due to a combination of oestrogen withdrawal, thermoregulatory changes and alterations in neurotransmitter systems.
Why do vaginal symptoms like dryness and dyspareunia occur during menopause?
Vaginal symptoms of dyspareunia (painful sexual intercourse), dryness and itch occur due to atrophic vaginitis secondary to low circulating oestrogen levels (epithelial thinning, muscular atrophy, reduced vascularity, loss of rugosity).
List the key symptoms of menopause.
○ Menstrual irregularity leading to amenorrhea ○ Vasomotor symptoms (hot flushes / night sweats ○ Mood disturbance ○ Sleep disturbance ○ Vaginal symptoms (dyspareunia, dryness, itch)
What are the two major complications of menopause?
Osteoporosis - due to increased bone turnover (normal oestrogen levels inhibit osteoclast activity). ● Increased cardiovascular risk - due to alterations in LDL:HDL ratio, raised serum cholesterol, arterial stiffening (among many other factors that are not entirely clear)
How is menopause typically diagnosed?
Typically diagnosed clinically - investigations are usually not indicated in women with menopausal symptoms over the age of 45.
When are investigations indicated for menopause?
When symptoms occur in younger women or when the diagnosis is uncertain.
What are the key diagnostic tests for menopause, if needed?
Serum FSH: elevated. Serum oestradiol: reduced.
Treatment of menopause can be beneficial for what?
for both symptomatic relief and cardiovascular / osteoporotic risk.
HRT should be prescribed in the ____ effective dose for the shortest duration of treatment possible.
lowest
What is the first-line management for menopause?
○ Regular excess ○ Weight loss (as necessary) ○ Avoidance of triggers (smoking, alcohol, spicy food).
What is the second-line management for menopause?
Hormone Replacement Therapy (HRT).
What forms of HRT are recommended for women with a uterus?
Oral or transdermal (patch) combined oestrogen and progesterone e.g. tibolone for systemic i.e. vasomotor symptoms, mood disturbance. ■ Note - in situ Mirena can act as progesterone component of HRT. ■ Topical oestrogen gel for local i.e. vaginal symptoms.
What forms of HRT are recommended for women withOUT a uterus?
Oral or transdermal oestrogen only treatment for systemic symptoms. ■ Topical oestrogen gel for local symptoms.
How is HRT adapted for perimenopausal women?
Monthly or 3 monthly cyclical regime to produce a protective bleed: ● Oestrogen daily, plus progestogen for 12 days every 4 weeks or 3 months
How is HRT prescribed for postmenopausal women?
(i.e. 12 months after LMP): ■ Cyclical or continuous combined regime: ● Cyclical (as above). ● Continuous oestrogen and progesterone daily
What are the key risks associated with systemic HRT?
Increased risk of breast cancer, which rises with longer use. Increased risk of venous thromboembolism.
Systemic HRT is associated with increased risk of _______. The longer its duration of use, the higher the associated risk.
Breast Cancer
Systemic HRT is associated with increased risk of ___ ______
Venous Thromboembolism
Does topical HRT carry the same risks as systemic HRT?
No, topical HRT is thought to have no effect on breast cancer risk due to minimal systemic absorption.
What are the absolute contraindications to HRT?
- History of breast cancer, any oestrogen-dependent cancer, current undiagnosed PV bleeding, current endometrial hyperplasia. 2. History of idiopathic VTE (if not anticoagulated). 3. Thromboembolic disease e.g. MI, angina 4. Liver disease. 5. Inherited thrombophilia. 6. Pregnancy.
