Menopause Flashcards
(18 cards)
Define menopause
when menstruation ceases
last menstrual period
average UK age = 51
What is early menopause?
menopause <45y
What is premature menopause?
menopause <40y
What is perimenopause?
the transitional period before menopause when hormone levels fluctuate, leading to various symptoms
begins when ovaries start to fail
When are you post-menopausal?
12 months of amenorrhoea
Symptoms/effects of menopause
changes in cycle
vasomotor symptoms
insomnia and irritability
panic attacks, forgetfulness, difficulty concentrating
headaches/migraines
vaginal dryness and dyspareunia
reduced libido
recurrent UTIs
stress and urge incontinence
thin hair, hair loss, brittle nails, aches and pains
Long term effects of menopause
loss of oestrogen:
- loss of bone density
- hypertension and atherosclerosis
- low mood, insomnia
How is menopause diagnosed?
no testing needed in over 45 with vasomotor symptoms and irregular cycles (perimenopausal)
no testing needed in over 45 and LMP >1y ago and not on hormonal contraception (menopausal)
no testing needed in over 45 with no uterus but menopausal symptoms
consider FSH testing if:
- 40-45y with menopausal symptoms
- suspicion of menopause in under 40
What is tibolone?
STEAR (selective tissue oestrogenic activity regulator)
oestrogenic, progestogenic and androgenic effects
used in HRT
HRT routes
tablets
pessaries
implants
transdermal patches/gels
IUS
vaginal cream
HRT benefits
vasomotor symptoms - hot flushes usually improve in 4 weeks
mood/sleep disturbances - alleviate night sweats
urogenital symptoms - max benefit 1-3 months but can take 1 year
oestrogens improve bone mineral density
Which HRT method increases VTE risk?
oestrogen tablets
do not give to patients already at risk of VTE - eg. obesity
Does HRT increase breast cancer risk?
Yes, Hormone Replacement Therapy (HRT) can slightly increase the risk of breast cancer, but the increase is low. The risk is generally higher with combined HRT (containing both estrogen and progestogen) compared to estrogen-only HRT, and the risk increases with longer durations of use
the risk of breast cancer begins to decline when HRT is stopped and by 5 years it reaches the same level as in women who have never taken HRT
Non-pharmacological management of menopause
CBT
lifestyle measures
vaginal moisturisers
phytoestrogens
How long should HRT be given in premature menopause and why?
until 50
to reduce osteoporosis risk
Who is given progesterone as well as oestrogen in HRT and why?
women with a uterus
to reduce risk of endometrial cancer
What is cyclical HRT?
Cyclical HRT, also known as sequential HRT, involves taking oestrogen every day and adding progestogen for a portion of the cycle, typically 10-14 days, to induce a monthly withdrawal bleed
for perimenopausal women still having some periods
cyclical approach helps maintain a healthy uterine lining and reduces the risk of irregular bleeding
What is continuous HRT?
involves taking both oestrogen and progestogen every day, without a monthly bleed
for postmenopausal women not having periods
