Menopause Flashcards
(43 cards)
What is the definition of menopause
The age at the last menstrual period
What is the climacteric
The time period from when the ovaries start to fail until 12 months after the last menstrual period
What is postmenopause?
The time after complete cessation of menstruation. Can only be determined after 12 mnths of amenorrhoea
Primary ovarian insufficiency definition
Menopause that occurs before age 40
What is the average age of menopause ?
51
What factors can result in early menopause? (3)
1- Genetic predisposition (30-70%)
2- type 1 diabetes
3- smoking
Hallmark endocrine changes of menopause
1- decreased inhibin B
2- increased FSH
What is the source of estrogen postmenopause
Aromatisation of androstenedione in peripheral tissues
What is the percentage fall of testosterone by the time of menopause
50%
What effect does decreased estrogen have in the body (4)
- decreases production of neurotransmitters
- decreased collage
- endothelial function
- atrophy of estrogen sensitive epithelial surfaces
What are the acute manifestations of menopause ? (4)
- cessation of menses
- vasomotor symptoms
- psychological: mood swings, panic attacks, depression, memory loss
- headaches
What percentage of women are affected by vasomotor symptoms?
70-80%
What is the median duration of vasomotor symptoms
7 years
What are the medium term symptoms of menopause? (5)
- vaginal dryness and dyspareunia
- reduced libido
- increased vaginal pH: >4.5 with recurrent UTIs
- atrophy GU tract : increased urge incontinence
- thinning skin, hair loss
What are the long-term health implications (2)
- increased fragility fractures
- increased Cardiovascular disease
What are the indications for HRT?
Significant vasomotor symptoms
What are the types of HRT (5)
- estrogen only
- sequential combined cyclic
- sequential combined long cycle
- continuous combined
- continuous progestogen
What are the different estrogen preparations? (4)
- transdermal estradiol
- oral conjugated equine estrogen
- subcutaneous estradiol pellets
- transvaginal: ring, tablets, cream
What are the routes of progesterone for hrt? (5)
- oral
- patch
- pessary
- cream
- IUS
What is a consequence of LNGIUS when used with estrogen
Doubles the risk of breast cancer
What is a consequence of tibolone
Doubles the risk of stroke
What is a benefit of the estrogen patch
Decreases the risk of venous thromboembolism
How does the patch decrease the risk of VTE
It by passes the gut and liver first pass metabolism hence preventing hepatic globin and coagulation factor synthesis
Benefits of oral estrogen (2)
- more affordable
- improves HDL LDL and cholesterol
