lecture 24 - women's health Flashcards
(21 cards)
what is premature menopause POI?
menopause occurring before the age of 40
why is early menopause?
menopause occurring before the age of 45
what is natural menopause?
menopause occurring around the age of 51. can be based on ethnicity, smoking status, lower education level or lower occupation level
how is menopause diagnosed?
diagnosis is based on symptoms in people aged 45 or over without the need for lab tests
menopause is confirmed if periods have been absent for 12+months if not on hormonal contraception
laboratory test eg FSH are not recommended for diagnosis in those over 45
consider serum FSH tests for those aged 40-45 with symptoms and menstrual changes
name 6 types of menopause symptoms
vasomotor symptoms: hot flushes, night sweats and temperature fluctuations
genitourinary symptoms: vaginal dryness, urinary issues (urgency, frequency, incontinence)
mood changes: depression and anxiety
mucoskeletal symptoms: joint and muscle pain
sexual dysfunction: low libido
sleep disturbances
what are menopause related health consequences?
depression and anxiety
dementia
cardiovascular disease
diabetes mellitus
metabolic syndrome
osteoporosis
migraienand sleep disturbances
vasomotor and MSK
what are osteoporosis risk factors
low bone mass dependant on age, family history, ethnicity, lifestyle, low body mass, oestrogen deficiency, early menopausal and secondary causes
additional risks are low bone mineral density, prior fragility fracture, glucorticoids, poor vision and poor balance
what is the first-lime treatment for moderate-to-sever menopause symptoms?
HRT systemic treatment of vasomotor symptoms . 3 months first review then yearly review
there is oestrogen only HRT or Combined HRT with oestrogen and progesterone. can be given as different formulation eg transdermal which is a gel or gel vs oral HRT. vaginal woestrogen has minimal absorption
what is the difference between sequential and continuous combined HRT?
the choice between sequential and continuous combined HRT depends whether the patient is still having their periods and time since menopause
sequential HRT is used for perimenopausal women <12m of last period
with oestrogen then daily and progesterone added in cycles. Progestogen for 12–14 days each month (for those with regular periods).
Progestogen for 12–14 days every 3 months (for those with infrequent periods).
continuous combined HRT is used for postmenopausal women ager over 54 with oestrogen and progesterone taken daily. it prevents unpredictable bleeding and is preferred or long term use
when is transdermal HRT preferred?
transdermal patches or gel preferred in high VTE risk, obesity, liver disease or migraines
oral HRT may be easier to take
what is the best HRT option for patients with a high risk of VTE?
transdermal oestrogen (patch or gel) and separate progestogen (if uterus intact). avid oral HRT as their is a higher risk of clot.
give examples of transdermal oestrogen and separate progesterone
oestrogen (transdermal patch) options are
- EVOREL 50/75/100 PATCH
- sandrena (gel, 0.5 = 1mg daily)
- Estrogel (1-4 pumps daily, flexible dosing)
progesterone (if uterus is intact)
- mirena (levonorgesterol IUS) - best option for endometrial protection
- utrogestan
Micronised progesterone (Utrogestan) has lower VTE risk than synthetic progestogens
Mirena coil provides local endometrial protection without systemic progestogen effects
what are preferred menopause treatments for women with a history of breast cancer?
Avoid systemic HRT under specialist guidance
For vasomotor symptoms (hot flutes and nights sweats)
CBT
SSRIs/SNRIs (venlafaxine 37.5 - 75mg, fluoxetine 30mg, sertraline 50mg, paroxetine 10mg - nocte - note paroxetine interacts with tamoxifen)
gabapentin 300mg off label for night sweats
clinidide 50mcg bd
what should be used in breast cancer patients with genitourinary symptoms?
genitourinary - vaginal dryness, urinary incontinence
non hormonal vaginal mosuturiers such as Sylk, YES, repels, hyalofemme
vaginal oestrogen eg ovestin cream, vagifem - only under specialist advice
Systemic HRT may increase breast cancer recurrence risk, so non-hormonal alternatives are first-line.
Vaginal oestrogencan be considered with oncologist approval, as systemic absorption is minimal.
why should oral HRT be avoided in women with migraines with aura ?
oral HRT increases the risk of stroke in these patients - prefer tx with transdermal oestrogen enrol patch or utrogesterone and separate progesterone progesterone if uterus in tats such as utrogesteroen 100mg nigh tr mirena its
HRT and Interactions
Drugs that induce CYP3A4 increase oestrogen and progestogen metabolism, reducing HRT effectiveness
Carbamazepine, Phenytoin, Phenobarbital, Primidone, Topiramate
Rifampicin, Rifabutin
Efavirenz, Nevirapine
St John’s Wort
Use transdermal HRT instead of oral(patches, gels are not affected by enzyme induction).
Consider higher doses of HRT if needed, but monitor symptoms.
how does menopause impact cardiovascular risk ?
oestrogen deficiency increases the risk of CVD in postmenopausal women
why are post menopausal women at a higher risk of osteoporosis
oestrogen deficiency leads o decreased bone density
What are some herbal alternatives to HRT?
Black cohosh, red clover, soy, St John’s Wort, gingko blob, progesterone cream, and compound bio-identical hormones
describe PCOS, endometriosis and UTIs
PCOS is an endocrine related disorder in reproductive women. symptoms include insulin resistance, hyperandrogensism and irregular periods
endometriosis is where there is endometrial tissue like growth outside the uterus.s symtopsm in include pelvic pain, infertility and dysmenorrhoea
UTIs and vaginal infections have a higher prevalence in women due to anatomical differences. symptoms include common pathogens such as E.coli and candida spp
why do we need to monitor HRT and anticoagulants ?
HRT can affect clotting factors, potentially altering anticoagulant effects.
Oestrogen increases clotting risk→May reduce anticoagulant effectiveness.
Direct Oral Anticoagulants (DOACs, e.g., Apixaban, Edoxaban)→ No major interactions, but monitor for bleeding risk.
Use transdermal HRT instead of oralto reduce clot risk.
Monitor INR closely in Warfarin userswhen initiating or stopping HRT.
Considernon-hormonal alternativesif clot risk is high.
