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Flashcards in Menopause Deck (19)
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Menopause - short-term consequences

1. Vasomotor symptoms (hot flushes and night sweats)
2. Sexual dysfunction (loss of desire, arousal, orgasm, dyspareunia)
3. Psychological symptoms (depression, anxiety, irritability, lethargy)


Menopause - long-term consequences

1. Osteoporosis
2. Cardiovascular disease
3. Urogenital atrophy


HRT - tx of local symptoms

1. Low-dose natural estrogens (e.g. vaginal estriol by cream/pessary)
2. Estradiol by tablet or ring


HRT - types of systemic therapy

1. Estrogen alone in hysterectomised women
2. Estrogen + progestogen in non-hysterectomised women
a. Estrogen + cyclical progestogen in peri-menopausal women
b. Continuous combined estrogen-progestogen in post-menopausal women


Menopause - definitions

- Menopause = permanent cessation of menstruation that results from loss of ovarian follicular activity (natural menopause = 12 consecutive months of amenorrhoea with no other pathological or physiological cause)
- Perimenopause = period beginning with the first clinical, biological and endocrinological features of the approaching menopause (e.g. vasomotor symptoms and menstrual irregularity) and ends 12 mo after the last menstrual period
- Climacteric = transition from reproductive state to non-reproductive state


Female sexual dysfunction (older women) - etiology (4)

Commonly multifactorial
1. Vaginal dryness (bc reduced estrogen) -> dyspareunia
2. Low sexual desire bc low androgen levels (evidence conflicting)
3. Non-hormonal factors (e.g. conflict between partners, life stress, depression)
4. Male sexual problems


Female sexual dysfunction - classification (4)

1. Loss of sexual desire
2. Loss of sexual arousal
3. Problems with orgasm
4. Sexual pain (dyspareunia)


HRT - routes of administration

Routes of administration of estrogen (4):
1. Oral
2. Transdermal
3. Subcutaneous
4. Vaginal

Routes of administration of progestogen (3):
1. Oral
2. Transdermal
3. Intrauterine


HRT - side effects

1. Estrogen-related: fluid retention, bloating, breast tenderness, nausea, headaches
2. Progestogen- related: fluid retention, breast tenderness, headaches, mood swings, acne
3. Combined HRT: irregular, break-through bleeding (may need investigation)


HRT - benefits

1. Reduced vasomotor symptoms (effective in treating hot flushes)
2. Reduced urogenital symptoms (note - urinary incontinence not improved by systemic therapy)
3. Improved sexuality
4. Decreased risk of osteoporosis
5. Decreased risk of colorectal cancer


HRT - risks

1. Increased risk of breast cancer
2. Increased risk of endometrial cancer with unopposed estrogen
3. Increased risk of VTE (but absolute risk still remains small)
4. Incraesed risk of stroke
5. Increased risk of gallbladder disease (but risk also increases with age and obesity)


Vaginal atrophy - symptoms

1. Dyspareunia
2. Itching
3. Burning
4. Dryness

(5. Caused by estrogen deficiency, may also be associated with atrophy of the lower urinary tract (5) -> frequency, urgency, nocturia, incontinence and recurrent infection)


Osteoporosis - definition

Reduced bone density causing microarchitectural deterioration of bone tissue, leading to an increased risk of fracture


Osteoporosis - epi

30% of women, 12% of men


Osteoporotic fractures - common sites

Can affect any bone, but most common sites:
1. Forearm (Colles fracture)
2. Spine (vertebral fracture)
3. Hip (most serious)


Osteoporosis - risk factors

1. Early menopause, being post-menopausal
2. Smoking
3. Corticosteroid use, Cushing's disease
4. Increased age
5. Heavy alcohol intake


Osteoporosis - clinical features

Asymptomatic until fracture occurs

1. Osteoporotic spinal fracture:
- Acute back pain or gradual onset of height loss and kyphosis with chronic pain
- Worsening of pain by movement and local tenderness

2. Peripheral osteoporotic fractures:
- Local pain
- Tenderness
- Deformity
- Often after an episode of minimal trauma

3. Hip fracture
- Affected leg is shortened and externally rotated


Osteoporosis - ix

1. **Dx = DEXA (dual energy X-ray absorptiometry)
- T-score = how many standard deviations the pt's BMD value differs from that of a young healthy control
- Z-score = deviation from age-matched controls
- Dx osteoporosis when T


Osteoporosis - mx

1. Lifestyle - smoking cessation, moderation of alcohol intake, dietary calcium intake, exercise
2. Falls risk assessment, referral to falls prevention team if recurrent falls or unsteadiness

Drug treatment if T