Menopause Flashcards
What is menopause?
-a permanent end to menstruation
When is a diagnosis of menopause made?
-after a woman has no periods for 12 months
What is the average year women experience menopause?
-around the age of 51 years, but this can vary significantly
What is postmenopause?
-the period from 12 months after the final menstrual period onwards
What is perimenopause?
- the time around the menopause including time leading up to the last menstrual period and the 12 month afterwards
- typically starts after 45 years
- women may experience vasomotor symptoms and irregular periods
What is premature menopause?
- menopause before the age of 40 years
- result of premature ovarian insufficiency
What is menopause caused by?
-menopause is caused by lack of ovarian follicular function which reduced the sex hormones associated with the menstrual cycle
What happens to the levels of oestrogen/progesterone and LH/FSH during menopause?
- oestrogen and progesterone are low
- LH and FSH are high as no negative feedback from oestrogen
Briefly describe the pathophysiology of menoupause
- begins with decline in development of ovarian follicles which leads to reduced oestrogen
- this means there is reduced negative feedback on the pituitary gland which leads to high FSH and LH
- this falling follicular development also means ovulation cannot occur resulting in irregular menstrual cycles
- without oestrogen the endometrium also does not develop leading to amenorrhoea
- the lower levels of oestrogen also cause the perimenopausal symptoms
What are the perimenopausal symptoms?
- hot flushes
- emotional liability or low mood
- premenstrual syndorme
- irregular periods
- joint pains
- heavier or lighter periods
- vaginal dryness and atrophy
- reduced libido
What are the risks associated with menopause?
- CVD and stroke
- osteoporosis
- pelvic organ prolapse
- urinary incontinence
*all due to lack of oestrogen
Do you need any investigations to diagnose menopause?
- diagnosis of perimenopause and mmenopause can be made in women >45 with typical symptoms without investigations
- FSH blood test can help with diagnosis in women < 40 yes with suspected premature menopause
Should women still use contraception after menopause?
Should use contraception for:
- 2 yrs after last menstrual period in women <50
- 1yr after last menstrual cycle in women >50
What contraceptions should be used with caution in menopause?
- Combined OCP should only be used up to the age of 50
- Progesterone depot injections (depo-provera) should not be used in women over 45 due to the decrease in bone density
What are the management options for perimenopausal symptoms?
- HRT
- tibolone
- clonidine
- CBT
- SSRI antidepressants
- testosterone - used to treat reduced libido
- vaginal oestrogen cream to help with dryness and atrophy
- vaginal moisturisers
