The Menopause Flashcards
What is the median age for the menopause?
51
When do we say the woman has gone through the menopause?
It is a retrospective diagnosis because the woman has to have been AMENORRHOEIC for 12 months before we stay she has been through menopause
If the woman is <50y she must have been amenorrhoeic for 2 years
What is the menopause?
Ovarian failure
No more remaining oocytes
What happens to hormones in the peri-menopausal period?
They will be extremely variable particularly of oestrogen and FSH
Levels of FSH and LH will increase because there is no oestrogen due to ovarian failure
What levels of FSH can be expected during the menopause?
FSH >30U/L - not a sensitive test because they fluctuate a lot in peri-menopausal period
FSH permanently elevated after menopause
What hormone is a better measure of ovarian reserve than FSH?
Anti-mullerian hormone
What are some symptoms of the menopause?
VASOMOTOR hot flushes - uncomfortable, troublesome at night and might have nausea, sweatiness and palps
VAGINAL BLEEDING - Irregular periods. If persistent or recurs after 12m amenorrhoea consider ix
ATROPHY - may cause PCB, discomfort and itch and increased infections
Mood changes, lethargy, cognitive change, fat distribution, insomnia, bladder symptoms, increased risk of breast cancer, osteoporosis
What is the basis of HRT?
Oestrogen replacement to ease symptoms
Usually given orally but can get transdermal patches
What are some side effects and risks associated with HRT?
N&V, Increased risk of breast and endometrial cancer, VTE, uterine bleeding, breast tenderness
How long is HRT usually given for?
2-3 years
What else can be used to specifically treat vasomotor symptoms?
Clonidine (acts indirectly on hypothalamus)
What form of HRT should be given to women who have not yet been amenorrhoeic for 12 months?
Systemic combined cyclical HRT
Helps cause predictable withdrawal bleeding
If a woman has been amenorrhoeic for 12 months what will she receive?
Systemic combined continuous HRT
What type of HRT would a woman with a previous hx of cancers (e.g. endometrial) be offered?
Oestrogen only HRT
What sort of treatment could be given if the atrophic, or urinary symptoms predominate?
An oestrogen ring or pessary for localised release
