Menopause Flashcards
(86 cards)
What are the most common difficulties menopausal women report at work?
- Poor concentration
- Tiredness
- Poor memory
- Feeling low
- Lowered confidence
Barriers to ethnic minority women seeking help with their menopause:
- Social stigma
- Menopause as a symbol of loss of fertility/femininity
- Lack of knowledge/health literacy
- Expectation not to complain/to cope
- Do not identify with narrative because education resources so no show ethnic minority women
- Language barriers
What is the mean age of menopause of women of African/Caribbean descent?
49.6
How may menopause differ in women of African and Caribbean descent?
- Longer duration of menopause transition.
- Highest prevalence and longest duration of vasomotor symptoms + more severe
- More likely to experience shorter sleep duration, more frequent awakenings and less efficient sleep.
- Smaller decline in sexual function and report a greater importance of sex
How may menopause differ in SE Asian women?
- May not complain of severe vasomotor symptoms
- May report a lower importance of sex and suffer more from low libido and sexual pain
- May suffer more from forgetfulness, joint and muscle pains.
- Have lower BMD but still have a lower risk of osteoporotic fractures than Caucasian women
What is the average age for Indian women (living in India) and Pakistani women?
Indian women (living in India) - 46.7
Pakistani women - 47.2
How may menopause differ in South Asian women?
- POI needs to be carefully considered in this population - women may have children earlier and their family complete by their mid-30s - they may not be worried about POI and they may not seek medical help which can then have implications for midlife health e.g. CVD, dementia, osteo etc.
- Indian women may complain more of vulval and uro-gynaecological symptoms
- There is a higher incidence of CVD risk factors during menopause transition such as metabolic syndrome, insulin
resistance & diabetes, central obesity and hypertension - Discussions about sexual health can be quite challenging and MH is not really talked about in these communities
How may HIV impact upon menopause?
- HIV is associated with an elevated risk of osteoporosis and cardiovascular disease, both of which are particularly increased among postmenopausal women
- Women with HIV 45-60 report high levels of menopausal symptoms
- Menopausal symptoms are associated with decreased adherence to ART
Key management points in those with HIV at menopause:
- Annual assessment of menopausal Sx in those >45
- As with women without HIV, bloods not routinely indicated over the age of 45 with Sx
- Use of transdermal preparations preferred due to lower risk of GI S/es and VTE
- There may be drug interaction between systemic HRT and some ART regimes - use drug checker
Which symptom is particularly more prominent following a surgical menopause?
Loss of libido
What may be the consequences of a surgical menopause?
- More severe consequences,
including increased rates of overall mortality, CHD, stroke, cognitive impairment, osteoporosis and sexual dysfunction - Evidence to suggest that the cardiovascular risk of
surgical menopause may be greater than a premature natural menopause. - Post-menopausal ovaries play a role in androgen production, theorising that a surgical menopause can impact libido more significantly compared to natural menopause
All women aged under what age should receive HRT until natural age of menopause following a surgical menopause?
Women under 45 years old
How should HRT in women with a subtotal hysterectomy be managed?
Should have an initial progesterone challenge - two cycles of sequential HRT - if no bleeding occurs, or pathology reports confirm no remaining endometrium then they can be managed on oestrogen-only HRT. Otherwise, long term they will require ccHRT
How should HRT in BRCA carriers be managed following a surgical menopause?
Swap to non-hormonal methods at age 50/51yrs
In whom may tibolone be particularly helpful?
Those with low libido, due to some androgenic activity
May also be useful in women whom have endometriosis, who have had a hysterectomy/BSO, but whom may have some endometrial deposits remaining
What is the BMS consensus status on breast cancer risk in women using HRT <50?
Women aged <50 years using HRT do not have an increased risk of breast cancer
How should the HRT of women with endometriosis be managed following a surgical menopause?
- ccHRT is advised in women who
have widespread endometriosis to reduce the risk of stimulation/malignant transformation of deposits - Changing to estrogen-only at a later date due to a better safety profile can be considered but must
be balanced with the risk of reactivating endometriosis and potential malignant transformation - HRT should be reviewed and suspended if symptoms recur.
How does age effect oestrogen dosing in HRT?
Younger women may require higher oestrogen doses to control Sx
Tips for discussing weight and nutrition with perimenopausal women:
- Ask women how they feel about their diet and lifestyle. Don’t go straight in if they aren’t ready or happy to discuss the issue
- Use a food and activity diary
- Agree two or three changes at a time
- Discuss strength exercise as part of a weight management regime. Regular, consistent weight resistance exercise is the most efficient method for increasing muscle mass and metabolic rate
and changing body shape
How can you practically start a conversation about weight and nutrition?
Ask a patient to rate how healthy they feel their diet and lifestyle is out of 10. If they respond with a
figure less than 10, ask them what they’d need to do to achieve 10/10. Their answer will give you a very good indication of where they sit with knowledge and beliefs about healthy living
On average, how much weight does a woman gain during the menopause transition?
1.5kg year, resulting in a 10kg weight gain by the time menopause is reached
How does body fat change during the menopause?
Weight accumulates around the abdomen and upper body. As oestrogen levels reduce, visceral fat increases from 5-8% total body weight to 10-15% total body weight. Concurrently, metabolic rate slows as lean muscle mass
reduces.
How much calcium does a woman require?
Satisfactory bone density score? 700mg
Osteopenia/osteoporosis? 1200mg
How often should women established on HRT be reviewed?
Annually
