Menopause Flashcards

1
Q

What is the menopause and why is it usually a retrospective diagnosis?

A

Last ever menstrual period

- retrospective as is only usually diagnosed after a year of amenorrhoea

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2
Q

What is the average age of menopause in the UK?

A

51

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3
Q

What ages would be considered an early or premature menopause?

A

Early menopause <45yrs

Premature menopause <40yrs

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4
Q

What age is considered a late menopause?

A

Late menopause >54yrs

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5
Q

Why do periods stop?

A
  • need ovulation for periods to occur
  • women are born with around 1 million eggs, but these are all lost by the age of 50
    => if no ovulation is occurring the woman cannot bleed
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6
Q

What effects of oestrogen are essentially “reversed” in the menopause?

A
  • Secondary sexual characteristics
  • Hair distribution, body shape + fat distribution
  • Effect on collagen
  • Bone growth
  • Proliferates endometrium
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7
Q

HOw is the menopause diagnoseD?

A

Vasomotor Symptoms
Pattern of periods
Blood tests? (sometimes)

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8
Q

What vasomotor symptoms do women often find the most debilitating?

A
  • Hot flushes
  • last for 3-5 mins
  • severe in around 20%
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9
Q

Why must multiple blood tests be taken to diagnose the menopause?

A
  • one single raised FSH/LH doesnt confirm
  • Normal FSH/LH doesnt exclude
  • Usually 2 blood tests 6 weeks apart
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10
Q

Why else may FSH levels be raised on a menopausal blood test?

A
  • prior to ovulation
  • Combined oral contraceptive OR Injection
  • Breastfeeding
  • Effect of certain medication (e.g. SSRI)
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11
Q

Why may a patient with a hysterectomy be more difficult to diagnose with menopause?

A
  • No abnormal bleeding pattern seen
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12
Q

Women who are happier in life experience less menopausal symptoms. TRUE/FALSE?

A

TRUE

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13
Q

What psychological symptoms can occur during menopause?

A
Mood swings
Irritability
Anxiety
Forgetfulness
Difficulty Concentrating
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14
Q

What other physical symptoms are common in menopause?

A
Night sweats
Palpitations
Insomnia
Joint aches
Headaches
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15
Q

What sexual symptoms are experienced by women in the menopause?

A

Vaginal dryness

Libido

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16
Q

What symptoms of the menopause usually appear later than others?

A

Urinary

  • Frequency
  • Recurrent UTIs
  • Dysuria
  • Incontinence
  • Skin and hair changes
  • Atrophy of breast and genitals
17
Q

What are the different types of perimenopausal dysfunctional uterine bleeding?

A

Irregular periods
Inter-menstrual bleeding (between periods)
Post menopausal bleeding

18
Q

If a woman experiences post-menopausal bleeding, what diagnosis do you want to rule out first?

A

Endometrial cancer

19
Q

What conservative management can be used in the menopause?

A
  • Diet/Weight loss/Exercise
  • Reduce caffeine
  • CBT/Mindfulness for hot flushes/mood swings
20
Q

What treatments can be used for menorrhagia?

A
  • Mefenamic acid (NSAID - decreases blood to uterus)
  • Tranexamic acid (antifibrinolytic - stops clot breakdown)
  • Progesterones
  • Intra-uterine system(IUS) - used for HRT, contraception, protection against endometrial cancer
  • Endometrial ablation
  • Hysterectomy
21
Q

If oestrogen only HRT is given, this can increase a woman’s risk of endometrial cancer. TRUE/FALSE?

A

TRUE

22
Q

How can HRT be given?

A
  • Patch
  • Oral
  • Oestrogen only (+ mirena coil to prevent cancer)
  • Combined
23
Q

What are the contra-indications for HRT?

A
Breast cancer
Abnormal vaginal bleeding
Endometrial cancer
Pregnancy
Active thrombo-embolic disorder
Recent MI
Active liver disease with abnormal LFT
Porphyria cutanea tarda
24
Q

Why is HRT given after a subtotal hysterectomy?

A
  • cervix is left in during this procedure
    => small bits of endometrium may also be left
  • certain types of HRT will cause this to bleed and show there is tissue left
25
Q

What Non-HRT methods are used to control symptoms of menopause?

A
  • Clonidine (antihypertensive with temperature regulation => useful if HRT contraindicated)
  • SSRIs

Vaginal Lubricants:

  • Regelle
  • Yes
  • Sylk