Menopause Flashcards
Definition of menopause and when is it early and when is it premature
12 months after final menstrual perios
Premature if <40
Early if <45
Sterility:
Amenorrheic for 1 year if >50
Amenorrheic for 2 years if <50
Risk for early menopause
Smoking
Surgery
Chemo
Radiation
List 3 symptoms in each category
1. Psychaitric
2. Vasomotor
3. Urogenital
4. Sex
5. Metabolic
- Mood changes
Impaired cognition
Somatic concerns - Hot flashes
Sleep disturbances - Skin changes
Dysparenuia
Vaginismus - Decreased libido
Less arousal
Less intense orgasms - Wt. gain
Increased LDL
Decreased bone health
When and what tests to do
Do TSH, Prolactin, HCG, LH, FSH, Estradiol
If atypical symptoms of <45 years old
If >45, it is a clinical diagnosis, no menses in 12 months
When to do endometrial biopsy
Any bleeding after 12 months of amenorrhea
How to investigate low libido
TSH
Don’t do serum androgen
What non pharm treatment can you recommend
CBT, HYpnosis, weight loss
No to alternative medicine like Black Cohosh
Quit smoking
Drink less alcohol
Drink less caffeine
Exercise more
Lose some weight
Dress in layers
Use a fan
Avoid hot drinks
Vaginal moisturizer like replens
Regular masturbation and intercourse
Kegal exercises
Pessary
CBT
Counseling
Optimize sleep
Top five:
1. Fan
2. Layers
3. Cool environment
4. Avoid hot drinks
5. Optimize sleep
What to do if someone has early ovarian failure
Put them on OCP until average age of menopause to decrease risk of adverse CV outcomes
How to treat the vasomotor symptoms with pharm management
HRT * first line
Desvenlafazine has best evidence
SSRI/SNRI (paroxetine), GABA, clonidine (messy SE hypotension/dizzy)
Maybe TCA
OCP
Progestin
Anticonvulsants
How to treat vaginal symptoms
Lubricant
Estrogen tablets
-Good because no contraindications except allergy
-Mix with lube if burning sensation
How to treat sexual health issues
Sometimes systemic/vaginal hormones can help as well
CBT
Relationship counseling
Sleep
Flibanserin (serotonin receptor agonist/antagonist)
Bupropion (off label)
Transdermal testosterone (off label)
How to determine which kind of HRT to give
If they have a uterus you have to give progestin, can’t have unopposed estrogen
TD is safest
Options for HRT
Oral: Premarin (estrogen)
Prometrium( progesterone)
Transdermal: estrogel (estrogen)
Estalis (combo estrogen and progesterone)
Vaginal
For estrogen- use lowest dose required to control ssx, and if uterus must have progesterone
For combo- variable, not dose response, pick what works
Contraindications for HRT
People that can’t have estrogen (migraine with aura, smoker >35 years old, uncontrolled hypertension, DVT, Stroke, CAD, DM, Liver disease, Malignancy)
more than 10 years since LMP limited utility but can still assess. Sooner HRT the better. Lowers risk Alzheimer’s.
On for more than 5 years or to 65, reassess yearly
What happens if you’re on HRT for more than 5 years
Risk of breast cancer increased by about 2% every 5 years
