Menopause Flashcards
(43 cards)
Define menopause?
12 months after last period
What is the average age of menopause in Australian women?
48-55 years old
Massecheuts womens health study 51.3 years old.
Define perimenopause and average age of perimenopause?
can range from 39 to 51 years old.
variable symptoms including bleeding problems, vasomotor symptoms, insomnia, dry vagina, low libido, night sweats, mood swings.
Why are menopausal women at risk of osteoporosis?
Loss of oestrogen as a anti osteoclast action.
Are there any ways of predicting how long a women will experience menopausal symptoms?
No, hormone tests are not useful.
What is the value of measuring the anti mullerian hormone and menopause?
Can be useful when combined US to check number of follicles. On its own, not a useful predictor of ovarian reserve and time till menopause.
How would you interpret a set of hormone blood tests including FSH, LH, Oestrogen?
In menopause, FSH may be elevated 10-20 times
LH may be elevated 3 times
Oestradiol is the principal oestrogen produced by the ovaries. In menopause, the small amount of oestrogen is produced by peripheral conversion of androstenidiene.
What is the mean duration of vasomotor symptoms?
average time is 5.5 years, some women get no symptoms. Some women may get symptoms longer.
Outline the 3 main groups of menopausal symptoms?
Vasomotor - hot flushes, night sweats
Urogenital symptoms - vaginal dryness, dyspareunia, urinary frequency
Sleep disturbance
Other symptoms include Mood swings weight gain aches and pains reduced concentration and memory fatigue skin changes thinning scalp decreased libido.
In a women who presents with suspected hotflushes, what history and physical examination would you perform?
history of presenting illness - vasomotor symptoms, urogenital, sleep disturbance. Associated symptoms General medical included CVD, obstetric and gynacological. sexual health menstrual history Risk factors for OP Smoking, alcohol, physical activity breast exam Papsmears Blood pressure
Name 1 questionaire you can administer to ascertain her symptoms of menopause?
Green score - found on UK menopause matters in website.
In a patient with suspected menopause, what investigations would you order?
Don’t do FSH, LFH, oestrogen and testosterone, unless younger than 45 years old.
investigatons targeted at preventative measures for fatigue and CVD
FBC, and ferritin for iron deficiency
LFT just in case need HRT
Lipids - HDL tends to fall when loss oestrogenic activity.
TSH
BMD in those medically indicated, ie early menopause
Mammogram
Papsmear
US uterus - is concerned about bleeding.
In patients with a previous hysterectomy, what forms of HRT would you prescribe?
Vaginal oestrogen in patients with primarily urogenital symptoms.
Continuous oestrogen in patients with a hysterectomy.
In a patient with premature menopause, what forms of HRT would you prescribe?
If less than 40 years of age, prescribe HRT until 50 years old unless contraindicated, or low dose COCP
Tibolone (not PBS listed)
In a patient during the menopausal transition, what form of HRT could you consider?
Low dose COCP in women with low CVD profile.
or
continuous oestrogen plus cyclic progesterone days 16-28 plus contraception ie barrier, sterilise, implanon.
Or
continuous oestrogen plus mirena IUD.
In a post menopausal lady with a uterus, what forms of HRT could you consider?
continuous oestrogen + cyclic progesterone if less than 12 months since menopause
Continuous oestrogen plus continue progresterone if menopause > 12 months
or
Tibolone (not PBS) use if > 12 months since menopause.
Does HRT cause weight gain?
No
Why would you consider a transdermal preparation over a oral HRT?
Transdermal HRT carries a lower risk of VTE, stroke, hypertriglyeridaemia.
In women with an intact uterus, treated with unopposed oestrogen, how long does it take for endometrial hyperplasia to occur?
6 months, so need progesterone as well.
Outline the bleeding patterns in women using HRT?
Obviously in post menopausal women, there will be no bleeding.
In women on continuous oestrogen and progesterone will have ammenorrhoea > 90%.
In women on cyclical progesterone and continuous oestrogen, most experience withdrawing bleeding after the last dose of progesterone, some women may get bleeding during the progesterone pills taken from 16 to 18 days.
What is your response to a women who asks you about the use of remifemin for the treatment for her menopause?
Blackcohosh - meta analysis - suggest no difference between taking placebo.
Name 2 foods that contain naturally occurring phytoestrogen?
soybeans and lentils
but much weaker than human oestogen.
What would be your advice be in patient who presents with HRT related migraines?
Try transdermal
Lower dose
Avoid systemic progestins
Use continuous therapy, no cyclical progesterone.
A 51 year old women who still gets irregular periods presents to you and asks at what age can she stop her oral contraception?
Can be advised to stop at 55 years old, as > 96% will be menopausal by this age.
Can measure FSH on at least 2 occasions over 2 months, may be helpful to predict ovarian failure.
If high risk of CVD, probably ask them to change to non hormonal or LARC.
Don’t use FSH in women younger than 50 years old and in women who are on COCP, as FSH not reliable in women using combined hormones.
