Menopause Flashcards
(14 cards)
What is premature ovarian failure?
Loss of ovarian function before age 40
Causes of premature ovarian failure
- Genetic – family history, certain genetic conditions
- Autoimmune predisposition – eg T1DM, Addisons, thyroid
- Iatrogenic – eg post-surgery, chemotherapy, radiotherapy
- Infections – TB, mumps
What is early menopause, perimenopause and menopause?
Early menopause - loss of ovarian function between 40-45
Menopause - loss of ovarian function and amenorrhoea for 1 yr
Perimenopause - beginning of ovarian function decline
Hormone levels in menopause?
- High FSH
- Low oestrogen
What are the menopause symptoms
- Vulvo/vaginal atrophy
- Painful sex (dyspareunia)
- Urinary problems
- Loss of libido
- Irregular periods
- Joint and muscle aches
- Mood changes/irritability
- Fatigue and sleep disturbances
- Hot flushes
Menopause diagnosis and ix
clinical diagnosis
Do bloods (FSH levels) if uncertain or early menopause or atypical symptoms over 45 - 2 samples 4-6 wks apart
- if taking oestrogen containing meds, stop for 6 wks before FSH blood test
Premature ovarian failure investigations and diagnosis
Menopausal symptoms incl amenorrhoea/oligomenorrhoea
FSH blood test, two samples 4-6 weeks apart
Hormonal profile
* LH, prolactin, oestradiol, testosterone, TFTs
Menopause management/treatment?
Supportive
* Regular exercise, maintain healthy weight
* Light/cotton clothing
* Use a fan
* Avoid triggers – stress, caffeine, spicy food, smoking, alcohol
* For sleep disturbances - sleep hygiene, avoid late exercise
* Mood - CBT, address stressors if possible
Medication
* Hormone replacement therapy (HRT) (oestrogen +/- progesterone)
* Urogenital symptoms - Vaginal oestrogen, vaginal moisturisers, lubricants
* SSRIs/SNRIs – eg fluoxetine, citalopram
Types of oestrogen HRT available
- Oral
- Transdermal – patches, gel, spray
- (Vaginal – cream, gel, pessary, ring)
Types of progesterone HRT available
- Present in tablets or combination
patches
OR - Mirena coil – up to 4y
- Utrogestan capsules (oral or vaginal)
Benefits and risks of HRT
Benefits - improves menopausal symptoms and reduces fragility fractures (esp if early menopause)
Risks
- VTE if oral HRT
- Breast cancer
- CVD in older than 60 pts (protective in younger)
- stroke
- ovarian cancer
HRT contraindications
- Previous or current VTE (unless on anticoagulants)
- Angina, CVD
- Thrombophilic disorder
- Current, past or suspected breast cancer
- Current or suspected oestrogen-dependent cancer
- Undiagnosed vaginal bleeding
- Untreated endometrial hyperplasia
- Liver disease / abnormal LFTs
- Uncontrolled hypertension
HRT review
3 months after starting then annually
assess efficacy and tolerability and if dose/route needs to be changed
How long is HRT prescribed for?
- Usually prescribed 2-5y (due to risks vs benefits), but can be longer or shorter
- Premature ovarian failure – until age of natural menopause (51y)
- Vaginal oestrogens usually long-term
