Menopause Flashcards
(15 cards)
What is the definition of menopause?
12 months after last period in women >50
24 months after last period in women <50
What are the features of perimenopause?
Change in the menstrual cycle e.g. shortening or lengthening of the period
Vasomotor symptoms
- hot flushes
- night sweats
Urogenital changes
- vaginal dryness- worsened by sex, itching
- urinary frequency
- post coital bleeding
- dyspareunia
Mood Disorders
- Anxiety/Depression
- Mood swings
Reduced libido
How is menopause diagnosed?
Can be a clinical diagnosis
FSH level
- >30 indicates ovarian insufficiency
- taken on 2 occasions 6 weeks apart
- used in younger people/uncertain
Should contraception be used in menopausal women?
Women can remain fertile for up to 2 years after last period if <50 (1 year >50)
POP can be used with combined HRT
COCP only if <50
How can you manage menopausal symptoms with lifestyle modifications?
Hot flushes
-regular exercise, weight loss, reduce stress
Sleep disturbance
- avoid late evening exercise, good sleep hygiene
Mood/Cognitive symptoms
- sleep, relaxation
What are contraindications of HRT?
Current or past breast cancer
Oestrogen sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
Liver Disease
Pregnancy
How do you determine what type of HRT to give?
1) Uterus or No Uterus
- if uterus cannot have unopposed oestrogen due to increased risk of endometrial cancer
- no uterus- oestrogen only HRT
2) Last period
- periods ongoing or last one <1 year then sequential combined HRT (oestrogen daily and progesterone for half month) for withdrawal bleed
- LMP >1 year continuous combined HRT oestrogen and progesterone daily, no bleeding
How long should HRT be continued for?
Continued as long as required until no longer required for symptoms
For those in premature menopause to continue until 51
Should gradually reduce dose as limits recurrence in short term
What routes can HRT be given?
Systemic oestrogen can be taken orally or transdermally
Transdermal oestrogen is not associated with VTE
How else can vasomotor symptoms be managed?
Fluoxetine, citalopram, venlafaxine
Clonidine
Gabapentin
How can vaginal dryness be managed?
Vaginal lubricant
How can urogenital symptoms be managed?
Vaginal oestrogen= 1st line
2nd line- oral ospemifene
Moisturisers or lubricants for dryness
What are side effects of HRT?
Oestrogen- breast tenderness, bloating, fluid tenderness
Progesterone- breast tenderness, low mood, acne
Vaginal bleeding
- especially in first 3 months and for Continuous Combined HRT can occur for 4-6 months
What are complications of HRT?
Increased risk of breast cancer
- related to duration, decreases when HRT stopped
Increased risk of endometrial cancer- reduced by adding progesterone
Increased risk of VTE
- transdermal does not increase risk
Increased risk of stroke
Increased risk of IHD
- if taken >10 years after menopause
When can COCP be used?
Can be used for menopause symptoms in women <50
