Menopause

Question 1

what are the phases of menopause?

Answer 1

premenopausal: up to 5 years before the last menstrual period
perimenopausal: presence of early menopausal symptoms w/ vaginal bleeding (this lasts till 12 months after the last menstrual period)
menopausal: 12 months since the last menstrual period
post menopausal: 5 years after the menopause

Question 2

how is menopausal diagnosed?

Answer 2

clinical diagnosis based on (1) age and (2) clinical sx:

if woman 45 but have to rule out other causes of menstrual cycle dysfunction
if woman > 45, diagnosis made based on change in intermenstrual interval w/ or w/o menopausal symptoms

Question 3

what are the most common symptoms of menopause?

Answer 3

irregular menstrual cycles 
hot flushes 
sleep disturbances 
mood symptoms: irritability, depression,  loss of concentration, poor short term memory 
vaginal dryness

Question 4

what are the absolute indications for HRT?

Answer 4

significant post menopausal sx and for sx relief (in particular hot flushes and vaginal atrophy)

Question 5

what are the benefits of HRT?

Answer 5

alleviates symptoms 
slows the development of osteoporosis 
prevents vaginal atrophy
lower rates of colorectal cancer
lower rates of diabetes

Question 6

what are the main contraindications to HRT?

Answer 6

hormone dependent cancer 
recurrent thromboembolism 
age > 65 and no prior use of HRT 
migraine with aura/neurological signs 
other conditions: 
CVS and cerebrovascular conditions 
liver disease
SLE
pregnancy

Question 7

what are the main risks of HRT use?

Answer 7

cardiovascular and cerebrovascular risk 
breast cancer risk if used over 5 years 
ovarian cancer risk
endometrial cancer risk if no use of progestin in women with uterus 
venous thrombosis
cholecystitis

Question 8

what are some common side effects of HRT?

Answer 8

(common in the first 2 - 3 months of use but will usually resolve and stabilize)

nausea/vomiting
premenstrual syndrome
bleeding irregularity or heavy bleeding
mastalgia

Question 9

what are the regimes indicated for women that are:

(1) younger
(2) older

Answer 9

younger: cyclic regimen (more predictable, controlled bleeding for better cycle control)
older: continuous regimen (more irregular bleeding and spotting, but induces amenorrhea and easier for compliance)