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Flashcards in Menopause Deck (51)
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1

what is menopause?

Cessation of menses for >12/12

2

Age of menopause?

Western women between 45-55 with average of 50-51y

3

What is early menopause?

Menopause before 45y

4

What is surgical menopause?

Bilateral oophorectomy

5

What are the phases of menopause?

-1. Premenopausal: 5y before LMP
-2. Perimenopausal: presence of early menopausal symptoms with vaginal bleeding (usu irregular)
-3. Menopausal: LMP
-4. Postmenopausal: ~5y after the menopause

6

Outline physiological changes of menopause

-Ovarian follicles decline rapidly
-FSH and LH increase (15x; 3x) that of the follicular phase ==> ovary doesn't secrete oestrogen but continues to secrete androgens

7

Urogenital aspects of oestrogen withdrawal?

-Epithelium of vagina, vulva, urethra and base of bladder becomes thin and dry
-can lead to dysuria, frequency, itching, dyspareunia and atrophic bleeding

8

How can the urogenital aspects of menopause be managed?

HRT can ameliorate urogenital dysfunction of menopause

9

What are the vasomotor symptoms of menopause?

-Hot flushes
-Night sweats
-Palpitations
-Lightheadedness / dizziness
-Migraine
-Formication (ants crawling under skin)

10

What are the psychogenic aspects of menopause?

-Irritability
-Depression / anxiety
-Tearfulness
-Loss of concentration
-Unloved feelings
-Sleep disturbance
-Mood changes
-Decreased self confidence

11

What are the urogenital symptoms of menopause?

-Atrophic vaginitis
-Vaginal dryness
-Dyspareunia
-Decline in libido
-Bladder dysfunction (e.g. dysuria)
-Stress incontinence / prolapse

12

Skin/tissue changes of menopause?

-Dryness
-Formication
-New facial hair
-Breast gland atrophy

13

Hx to elicit in menopause evaluation?

-Menstrual Hx
-Other Sx related to oestrogen deficiency (esp hot flushes, mental state)
-Sexual Hx (contraception, microturition, relationships)
-FHx: osteoporosis, CVD, Ca

14

PEx in menopause evaluation?

-BP, height and weight
-Breast exam
-Abdo exam
-Vaginal exam
-Pap smear

15

Ix to consider in menopause work up?

-Urinalysis
-FBE
-Lipids
-LFTs
-Mammography (better 3/12 pre or post HRT)
-Diagnostic hysteroscopy and endometrial Bx IF undiagnosed vaginal bleeding
-Bone density (if RFx)

16

What is the role of hormone Ix? What are they?

If diagnosis is in doubt (e.g.

17

Ddx of menopausal Sx?

-depression
-anaemia
-thyroid dysfunction
-Hyperparathyroidism
-Gynae d/o (e.g. dysfunctional bleeding)

18

Mx of menopause?

-Importance healthy lifestyle
>diet, exercise
>smoking, caffeine
>pelvic floor exercise
-Sexual activity + lubricant
-Discuss HRT
-Osteoporosis screen, Vit C and D

19

Points to emphasise when discussing HRT?

-HRT pros: decreases symptoms, enhances QoL, reduces risk of bowel Ca, osteoporosis and fractures
-HRT negs: increased risk of endometrial hyperplasia, breast Ca and VTE

-no firm evidence of increased risk of breast Ca

20

What are the hormones for consideration in HRT?

-Oestrogen
-Progesterone
-Testosterone

21

Methods of oestrogen delivery?

-Oral
-Patches (most used worldwide)
-Implants
-Topical
(also injectable but rarely used)

22

What is the role of topical oestrogen?

Usually restricted to women with mild symptoms seeking management of urogenital aspects who cannot tolerate oral

23

What are the oral oestrogens in common use?

-Premarin
-Ogen
-Progynova

24

What is the role of progesterone in HRT?

Given to women with a uterus; prevents hyperplasia of uterus 2" unopposed oestrogen therapy (increases risk of Ca)

25

Progesterone cyclical or continuous?

If cyclical, D1-12 of calendar month but gives withdrawal bleed so many prefer continuous.

26

What is the golden rule of HRT?

Progestogens must be given with oestrogen in a woman with a uterus

27

Testosterone in HRT?

For women whose libido does not improve with HRT: use cautiously, little data re AEx
-always give with oestrogen
-given as implant

28

What is tibolone?

Selective tissue oestrogen activity regulator (combined oest, prog and androgen properties): alternative to conventional HRT.
Adverse effects of breakthrough bleeding and virilisation are concnerning

29

Contraindications to HRT?

-Oestrogen dependent tumour
-Recurrent VTE
-IHD acutely (absolute)
-Hx of CAD (relative)
-Stroke
-Uncontrolled HTN
-Undiagnosed vaginal bleeding
-Active liver disease
-Active SLE
-Pregnancy
-Otosclerosis
-Acute intermittent porphyria

30

AEx HRT?

-PMS: decrease dose progestogen or change
-Nausea/breast d/os: initial sensitivity to oestrogen. Reduce to starting dose or change to intravaginally
-Bleeding problems: heavy (dec oestrogen) / breakthrough (increase progestogen) / irregular (Ix and endometrial sampling) / intolerance (continuous regime of progestogen)