Menopause Flashcards by Ella Oakley

At what age does perimenopause typically begin? What is the average age of menopause?

Around 45 years old
51 years

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What hormonal change is characteristic of perimenopause?

Fluctuating hormone levels

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What are common symptoms experienced during perimenopause?

Hot flushes and night sweats

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What hormone level is typically elevated during perimenopause?

FSH levels

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What is the primary physiological cause of menopause?

Decline in oestrogen levels

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What are the potential impacts of menopause on a woman’s life?

Emotional, psychological, social, sexual and cultural

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What physiological event defines menopause?

Loss of ovarian follicular function

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What type of assessment is recommended for menopause management?

Biopsychosocial assessment

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What marks the end of reproductive life?

Menopause

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How is menopause diagnosed retrospectively in women over 50? How is menopause diagnosed retrospectively in women over 40?

1 year of amenorrhoea
2 year of amenorrhoea

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What is premature menopause also known as? At what age is menopause considered premature?

Premature ovarian insufficiency
Under 40 years

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What are the physical symptoms of menopause?

Hot flushes/night sweats (affects 75% of women)
Sleep disturbance
Menstrual irregularities
Joint and muscle pain
Tiredness and lack of energy
Vaginal dryness and dyspareunia
Palpitations
Skin/hair changes
Urinary problems/incontinence
Weight gain

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What are the psychological symptoms of menopause?

Mood changes and irritability
Loss of libido
Anxiety
Cognitive disturbance

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What is a common gynaecological symptom of menopause?

Uterovaginal prolapse

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What is typically diagnostic in a woman aged over 45 years? What should be excluded before diagnosing menopause? When should other differentials be considered in menopause assessment?

History
Red flags like continuous vaginal bleeding
If ATYPICAL symptoms of ovarian failure

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What are some differentials to consider if ATYPICAL symptoms of ovarian failure are present?

Anxiety or panic disorder
Alcohol-induced symptoms
Tuberculosis
Drugs

What does the Lancet 2024 advocate for in menopause management?

Empowerment towards de-medicalising treatment

How long do vasomotor symptoms typically last?

4-7 years

What can worsen hot flushes during menopause?

Stress and anxiety

What should be discussed in a patient’s individual context during menopause? What therapy can help reduce menopausal symptoms and improve quality of life?

Discuss risk in patient’s individual context
CBT

What lifestyle options are available as treatment for menopause?

Regular exercise
Healthy diet and BMI
Stop smoking
Reduce alcohol
Avoid symptoms triggers e.g. spicy food
Reduce stress
Relaxation exercises
Sleep hygiene

Does HRT reduce the risk of dementia?

No evidence HRT reduces risk of dementia

What are some alternatives to HRT?

CBT for low mood and anxiety
Isoflavones (soy) and black cohosh may help flushes but preparations vary in content/safety
Evidence supports use of SSRIs and SNRIs in women who can’t/don’t want HRT
Raloxifene – osteoporosis
Clonidine – hot flushes

For whom is oestrogen-only HRT indicated? When is Oestrogen-only HRT prescribed with an IUS?

Women who have had a hysterectomy
For women with a Mirena coil

For whom is sequential combined HRT indicated? How does sequential combined HRT work? What does the sequential progesterone in HRT do?

For perimenopausal women Daily oestrogen with sequential progesterone Trigger a bleed

For whom is continuous combined HRT indicated?

For postmenopausal women

How long since the last period indicates use of Continuous combined HRT if greater than 50?

> 12M since last period

How long since the last period indicates use of Continuous combined HRT if less than 50?

> 24 M since last period

When should bleeding be investigated in hormonal treatment?

If persistent and abnormal beyond 6 months

What is the 1st line treatment for vasomotor symptoms? What is the 1st line treatment for low mood during menopause?

Hormone replacement therapy (HRT) Hormone replacement therapy (HRT)

What are the contraindications to HRT?

1. History of breast cancer or oestrogen dependent tumor 2. Untreated endometrial hyperplasia 3. Undiagnosed vaginal bleeding 4. Uncontrolled hypertension 5. Arterial thromboembolic disease 6. Current or recurrent VTE (unless anticoagulated) 7. Thrombophilic disorder 8. Liver disease (abnormal LFTs)

What are the beneficial effects of HRT?

Sexual function Urogenital atrophy Bone mineral density

Is migraine a contraindication to HRT?

No, but use transdermal

Which has a greater impact on breast cancer risk: HRT or lifestyle factors like obesity? Which HRT preparations have a higher VTE risk: oral or transdermal?

Lifestyle factors like obesity Oral preparations

Does HRT increase CVD risk in women > 65 years? Which HRT increases the risk of stroke: oral or transdermal? What is the impact of HRT on ovarian cancer risk?

No, HRT does not increase CVD risk Oral HRT increases risk Slight increased risk from epidemiological studies

What are alternative treatments for menopause?

1. Testosterone for persistent sexual dysfunction 2. Hypnosis, mindfulness or relaxation therapy may improve severity and frequency of vasomotor symptoms 3. Limited evidence for phytoestrogens and isoflavones (soy) – avoid in women with breast cancer due to potential oestrogenic activity 4. Pregabalin and gabapentin – short term data suggests reduction in vasomotor severity and frequency compared to placebo. Neither licensed for use in menopause 5. Clonidine licensed for treatment of vasomotor symptoms 6. Neurokinin 3 receptor antagonist can help manage hot flushes