Menopause Flashcards
(45 cards)
Define menopause
After 1 year has passed since a woman’s last period
What is the average age of menopause?
51
What is perimenopause?
5 years or so before menopause where the woman undergoes hormonal and psychological changes and are experiencing symptoms
Define premature menopause
Menopause at 40 or before 40
Why does menopause occur?
Ovarian insufficiency
Reduced no. of functional follicles/reduced sensitivity of remaining follicles to FSH and LH –> oestradiol falls, GnRH, FSH and LH rise (but their secretion becomes very erratic) –> symptoms of perimenopause
Where can some oestradiol still come from in the body?
Peripheral conversion of adrenal androgens in fat
Menopause can occur naturally, how else may it occur?
After oophorectomy, chemo or radiotherapy
What are the symptoms of menopause?
Muscle/joint aches Hot flushes Vaginal dryness Low libido Mood changes/memory problems Osteoporosis
Define osteoporosis
Reduced in bone mineral density
How do you monitor osteoporosis?
DEXA scan, T score, FRAX score
What is the issue with osteoporosis?
Woman at increased risk of fractures
What things would lead to a high FRAX score?
Thin, Caucasian, smoker, alcohol use, +ve FH, steroids, malabsorption, hyperthyroidism
How can prevent/treat osteoporosis?
Exercise, vit D/calcium supplements, bisphosphonates, denosumab (monoclonal Ab against osteoclasts), teriparatide
How can you treat menopause?
HRT Selective oestrogen receptor modulators SSRI/SNRI antidepressants Natural methods Non-hormonal vaginal lubricants
What are the two forms of HRT you can use?
- SYSTEMIC
Patch (avoids first pass met –> less VTE risk), oral, gel
Oestrogen only if no uterus
Oestrogen and progesterone if uterus - LOCAL
Vaginal oestrogen only (pessary/ring/cream)
Minimal absorption so no increased VTE/breast ca risk
Why must you give progesterone to someone in systemic HRT who has a uterus?
Unopposed oestrogen has a proliferative effect on the endometrium so may lead to endometrial hyperplasia
What are the different ways you can give progesterone as HRT?
LNG IUD, transdermal patch, POP
What are the contraindications to HRT?
Current hormone dependent cancer of breast/endometrium, current active liver disease, uninvestigated abnormal vaginal bleeding
Seek advice about prev. VTE, thrombophilia, FH VTE, prev. breast ca/BRCAn carrier
Why might we not do continuous combined HRT?
What is the alternative?
Despite it being assoc. w lower endometrial cancer risk, may lead to inconvenient breakthrough bleeding if still some ovarian function
Can do cyclical combined - 14 days oestrogen 14 days oestrogen and progesterone (withdrawal bleed after stopping progesterone)
NB any age can use mirena and daily oestrogen
What are SERMs?
Have oestrogen effect on selective organs
Used to treat vasomotor symptoms assoc. with menopause
What natural methods can you use for menopause symptom treatment?
Phytooestrogen (red clover, soy, black cohosh)
Hypnotherapy, CBT, exercise
What are the benefits of HRT?
Improves vasomotor and local genital symptoms
Reduces risk of osteoporosis and bowel cancer
What are the risks of HRT?
Breast Ca if combined HRT (and BMI >30, or >14u EtOH/wk & returns to normal after 5y of cessation), ovarian cancer
VTE and CVA if oral route
What are the HRT use NICE guidelines?
Rx of severe vasomotor symptoms - review annually
For woman with premature ovarian insufficiency - HRT benefits outweigh risks until 50
Not first line Rx for osteoporosis - use bisphosphonates
Vaginal oestrogen for vaginal symptoms
