Flashcards in Menopause Deck (29)
What is 'the menopause'?
is the final menstrual period
When is menopause Dx?
after 1 year of no menstruation
What is menopause transition?
The time from onset of menstrual cycle changes or vasomotor Sx (VMS) (hot flushes and night sweats) until 1 yr after final menstrual period
What are the core Sx of menopause?
2) Sleep disturbances
3) Vulvo-vaginal Sx (incl. dryness)
Does menopause cause weight gain?
No (but fat distribution may change--> central fat deposition)
When is the avg. age of menopause?
What are the Sx a/w menopause?
1) VMS (hot flushes, night sweats)
2) Sleep disturbances
3) Vuvlovaginal Sx (vaginal dryness, urinary dysfn, sexual dysfn)
4) Mood disturbances
What should you always exclude in women with oligomenorrhoea, amenorrhoea, VMS etc?
What is premature menopause?
When menopause occurs in women aged
What is premature menopause also known as?
premature ovarian insufficiency
What is premature menopause a RF for?
1) osteoporosis and fracture and 2) may increase the risk of heart disease.
What are 2 other important causes of menopause?
What can chemoRx for breast and haem Ca commonly lead to?
What test can you do, if menopause is not clear on Hx?
Take two FSH and estradiol measurements six weeks apart:
a. Elevated FSH (around 25 U/L) and low estradiol
what are the measurements of FHS and estradiol that would suggest menopause in blood tests?
Elevated FSH (around 25 U/L) and low estradiol
When is the blood test for menopause not indicated?
These blood tests are not indicated to diagnose menopause in women aged > 45 years.
If pt is
If pt is>50, should contraception be recommended? And what would you suggest?
If aged > 50 years, contraception is recommended for one year after the final menstrual period.
Condoms or progestogen only forms of contraception are advised for women aged ≥ 50 years
What's good about low dose COCP?
They will treat vasomotor symptoms and reduce fracture risk.
Should you screen for anxiety and depression?
Summary of Mx plan
1) Provide info about menopause
2) Provide advice for optimal bone health
3) Mx of VMS
4) Consider vaginal oestrogens if urogential Sx or recurrent UTIs
What advice would you give for optimal bone health?
1) Lifestyle advice
2) Healthy diet (incl. 1300mg calcium daily)
3) Physical activity- 150mins/week, incl. resistance training
4) smoking cessation
5) EtOH in moderation
How would you Mx VMS?
a. Avoid triggers such as caffeine, EtOH and spicy foods
b. Layer clothing and reduce bed covers
c. Relaxation, mindfullness and CBT may help
d. Complementary and herbal therapies have not been shown to be safe or effective for vasomotor Sx
e. For pts with moderate or severe Sx, see HRT
What are some urogenital Sx?
1) Vaginal dryness
4) Pain with intercourse
5) Mild bleeding
6) Pain with urination
7) Recurrent UTIs
8) Persistent smelly discharge
How to reduce vulvovaginal symptoms?
How long till Sx are improved with vaginal oestrogens?
When are vaginal oestrogens CI?
When there is undiagnosed vaginal or uterine bleeding, or endometrial cancer.
How can you get vaginal oestrogens and the dose?
1. Oestriol vaginal cream 1 mg/g (Ovestin) 1 applicator intravaginally at bedtime every night for 3 weeks, then continued at a maintenance dose of twice a week.
2. Oestradiol pessary 10 mg (Vagifem Low) 1 pessary intravaginally at bedtime every night for 2 weeks, then 1 twice a week thereafter.