Menopause (1) Flashcards
What is it defined as?
→ When does it occur?
→ What is it caused by?
What is Perimenopause?
→ How long can this last?
What is Early menopause?
What’s it called if menopause occurs < 40yrs?
➊ Permanent cessation of menstruation for > 12 months
→ Between 45-55 yrs, with average of 51
→ Ovarian failure, which leads to oestrogen deficiency
➋ Menopausal transition – Period from when menopausal symptoms start until 12 months after LMP
→ 6-10 yrs
➌ Menopause between 40-45yr
➍ Premature Ovarian Insufficiency
What’s the mechanism that occurs in menopause?
→ What are the 2 effects of the ↓Oestrogen?
What hormonal state will post-menopausal women be in?
➊ Reduced follicle count - ↓Oestrogen levels and less negative feedback, leading to ↑LH/FSH
→ • Causes the symptoms
• Becomes too low to stimulate the endometrium → Amenorrhoea
➋ ↓Oestrogen and ↑LH/FSH
How does it present?
What are its long-term effects?
➊ • Vasomotor – Hot flushes, Night sweats (Sleep disturbance)
• Genitourinary Syndrome
‣ Sexual dysfunction – Atrophic Vaginitis (Dryness, Itchiness, Atrophy, Burning, Painful sex, PCB)
‣ Urinary tract disorders (Dysuria, Frequency, Urgency, Recurrent UTI)
• Psychological – Anxiety and mood disorders, Fatigue, Cognitive impairment
➋ Heart (CVD, Stroke, TIA), Bone (Osteoporosis, Fracture)
Investigations:
What should be done if < 45 yrs?
What should be done if > 45 yrs?
→ Why aren’t androgen levels tested here?
➊ History and Bloods:
• FSH - Repeat at least 4 weeks apart - should be >30 iu/L
• Make sure they’re not on COCP or HRT
• If level is pre-menopausal, repeat in a year
➋ Check Periods and Symptoms
→ Clinical features are often more than enough for a diagnosis
Management:
What is the mainstay of it?
→ How can it be given?
→ What are its benefits?
→ What does it increase the risk of?
What else can be given?
➊ HRT
→ Cyclically for pre-menopausal women, or Continuously for post-menopausal women
→ • Relief of Vasomotor and Urogenital symptoms
• Reduces the risk of osteoporosis
→ VTE, breast ca., and endometrial ca. (if oestrogen alone)
➋ • Testosterone for sexual dysfunction
• SSRI, CBT for Anxiety and mood disorders
Premature Ovarian Insufficiency:
What is this?
What are the causes?
What will investigations show?
How is it managed?
→ When would you consider adding testosterone to this?
➊ Menopause < 40yrs
➋ Idiopathic, Iatrogenic, Genetic, Autoimmune
➌ Raised FSH (should be repeated 1+ times)
➍ HRT until around 51yrs
→ If bilateral oophorectomy
Hormone Replacement Therapy:
What are its components given for?
What are the ways in which it can be given?
What are its side-effects?
➊ * Oestrogen for symptoms
* Progesterone for endometrial protection
➋ * Cyclical if pre-menopausal
→ Give this monthly if they continue to have regular periods
→ Give this every 3 months if they continue to have irregular periods
* Continuous if post-menopausal
➌ Breast tenderness, Headache
