Menopause Flashcards
(25 cards)
Definition of menopause?
The last period
Average age is 51 years
Define the climacteric?
AKA perimenopause; it is the period leading up to the menopause
What is early menopause?
<45 years
What is premature menopause?
<40 years
What is late menopause?
> 54 years
Physiology of ova from birth?
Women are born with all the eggs they will ever have; these exist in follicles
FSH and LH are secreted from the anterior pituitary and oestrogen is secreted from granulosa cells
Effects of oestrogen?
Development of secondary sexual characteristics
Affects hair distribution, body shape and fat distribution
Decreased collagen (causes vaginal dryness)
Affects bone growth
Proliferation of the endometrium
NOTE - this is why oestrogen replacement is important
When do levels of FSH rise?
At menopause
Just prior to ovulation
Stopping COCP or depo
With breastfeeding or certain medications, e.g: SSRIs
Ix for menopause?
Sometimes FSH is checked; generally, it rises at, although this does not confirm menopause
Physical symptoms of menopause?
Hot flushes and night sweats (vasomotor symptoms)
Palpitations
Insomnia
Joint aches
Headaches
Amenorrhoea (can also have irregular bleeding and menstrual issues)
NOTE - due to the lack of ovulation, FSH levels continuously rise in these women; the result is raised, unopposed oestrogen which can lead to a continously proliferating endometrium, until an almighty period occurs
Psychological symptoms of menopause?
Mood swings
Irritability
Anxiety
Difficulty concentrating
Forgetfulness
Sexual symptoms of menopause?
Vulvovaginal atrophy, causing vaginal dryness
Loss of libido
Later symptoms of menopause?
Frequency, dysuria, incontinence
Recurrent UTIs
Dry hair and skin (fat distribution changes)
Atrophy of breast and genitals
Manifestations of perimenopausal DUB?
Irregular periods
Inter-menstrual bleeding (IMB)
Post-menopausal bleeding (PMB)
Conservative management of menopause symptoms?
Lifestyle measures: • Diet • Exercise • Weight loss • Caffeine reduction
Management of menorrhagia?
- Mefenamic acid OR tranexamic acid
- Progesterones
• POP (AKA mini-pill)
• Depo-provera - Mirena IUS
- Endometrial ablation
- Hysterectomy
What is the best treatment for symptomatic menopause?
Hormone Replacement Therapy (HRT)
Types of HRT?
1st line options are generally oestrogen & progesterone based:
• Continuous combined HRT -
used if it has been >2 years since menopause
• Sequential/cyclical combined HRT - used if <2 years since menopause OR if menopausal symptoms but still have periods
Oestrogen-only HRT options are available (usually only if hysterectomy):
• Tablet, patch or gel
• Mirena coil
Local (topical) vaginal oestrogen cream or tablets can be used for patients with vaginal dryness, etc
Give dietary and contraceptive advice
Indications for oestrogen-only HRT?
Hysterectomy (these patients do not require progesterone)
Woman who have a Mirena, as the oestrogen will already be opposed
NOTE - for some women, the Mirena AND an oestrogen-only option is used, due to the risk of endometrial cancer assoc. with unopposed oestrogen
Issues assoc. with unopposed oestrogen and oestrogen-only HRT?
Increased risk of endometrial cancer
Explain sequential/cyclical HRT
2 types:
• Monthly HRT - oestrogen every day and progestogen for last 14 days of menstrual cycle
• 3-monthly HRT - oestrogen every day and progestogen for last 14 days, every 3 months
Explain continuous HRT
Oestrogen and progestogen every day, without a break
Benefits of HRT?
Symptom control and better QoL
Reduced incidence of oesteoporotic fractures
Reduced incidence of bowel cancer
Potentially protective against Alzheimer’s and Parkinson’s disease
If used between the ages of 50-59 and if it has been <10 years since menopause, there is a lower risk of CV events and CHD
Risks assoc. with HRT?
VTE
CVA
Breast cancer
Gallbladder disease
Use of HRT >20 years after menopause is assoc. with increased risk of CV events and CHD
