menopause Flashcards
(40 cards)
what is menopause
cessation of menstruation dg by 12 months of amenorrhoea
physical sx d/2 reduction of estrogen &; progesterone
betw/ 45-55
precceded by perimenopause (transition)
when is menopause premature
before 40 years of age
-smokers- 2 years early
define perimenopase
period from the first occurrence of climacteric irregular menstruation cycles to the last menstrual period
begins 45-55 years
define menopause
Time at which menstruation ceases permanently
Confirmed after 12 months of amenorrhea
define postmenopause
12 months after the last menstrual period and onwards
what is surgical menopause
amenorrhea d/2 removal of the ovaries after a hysterectomy w/ bilateral salpingoophorectomy typical in endometrial cancer
RF for early menopause
Smoking
Hysterectomy/oophorectomy
Living at high altitude
History of previous chemo/radiotherapy
PP/ how does menopause happen
ovarian follicles make estrogen then progesterone both of which have a -ve on FSH and LH in ant pit
no of ovarian follicles are fixed and decline w/ age and their quality decreases also
leading to reduced ovarian func and reduced lvls of estrogen and progesterone
FSH & LH lvls increase in estrogen abscence -> down reg of follicle receptors To FSH
causes HYPERGONADOTROPIC HYPOGONADISM
(lack of sex hormones d/2 pit/hypothalamus// 2ndary&tertiary)
hormonal imbalance causes irregular menstruation d/2 loss of progesterone and esterogen regulated activites
eventual loss of all ovarian follicles and ovarian function
amenorrhea
where does the mmajority of estrogen come from in menopausal women
conversion of androgens into estrogen by AROMATASE
sx of menopause (9)
A&A
↓ estrogen diseases
vessel & (psych)
w&b
long term: heart 💓& bone 🦴
1) amennorhea or irregular menses leafing to amenorrhea
2) atrophy
- smaller tender breasts (mastodynia)
- vulvovaginal atrophy -vaginal dryness= DYSPAREUNIA
- bladder and urethral atrophy-INFEC/INCONTINENCE
3) autonomic sx
- sweating, hit flashes, heat intol 75%
4) psychiatric sx
- insomnia/nightsweats
- mood swings/ depressh
5) weight gain and bloating
6) Ischaemic Heart Disease increases
7) alleviation of estrogen mediated diseases
- endometriosis, adenomyositis, fibroids
8)pathological fractures
When do sx 1st occur
(begin up to 6 years before the final menstrual period and continue for a variable number of years after the final menstrual period)
Cause of hot flush
starting on the face and spreading down the neck and chest.
begins from the umbilical area and moves upward toward the head, followed by sweating of the head and upper body.
Can be severe enough to prevent sleep (psych)
Can accompany palpitations likening it to HYPERTHYROIDSM
These are associated with peripheral vasodilation and a transient rise in body temperature. The exact mechanism is unknown but it is thought to be due to pulsatile LH release influencing central temperature control.
Why is there bladder atrophy
bladder and urethra share embryological derivation with the uterus and vagina so is affected by lack of estrogen in the same way
Why IHD In menopause
oestrogen reduces levels of LDL cholesterol whilst raising HDL cholesterol. After menopause women experience the same frequency of cardiovascular disease as men.
Why osteoporosis in menopause
Oestrogen protects bone mass and density through reducing the activity of oesteoclasts.
With the drop in oestrogen this balance is tipped and there is an increase in bone reabsorption resulting in an acceleration of age related loss of bone density and increased frequency in fractures especially of the wrist and hip.
Investigations for menopause
history of typical clinical sx
LAB
- ↓ progesterone ↓ estradiol and ↓ inhibin are early signs starting 2 years before the final menstrual period and stabilizing approximately 2 years after the final period)
- ESTRONE which is aromatized from androstenedione is predominant estrogen in menopause
- reduced renal clearance of FSH in comparison with LH so FSH levels are higher than luteinizing hormone (LH) levels, and both rise to even higher values than those seen in the surge during the menstrual cycle. FSH ELEVATION IS DG but LH isn’t
- lipid profile: ↑ total cholesterol, ↓ HDL
Dx. 1) HTHserum TSH d/2 sim presentation. 2) atrophic cystitis presents sim to uti => urine analysis
US of endometrial thickness
Endometrial biopsy- thickness and any hyperplasia above 5cm
DEXA SCAN for
osteoporosis screening w/ in women over 65
How often should FSH be checked in menopause
every 2- to 3-months
- helpful for establishing whether the woman is progressing through menopause.
Women with elevated, but not postmenopausal, FSH levels are still at risk for pregnancy, and contraception should continue to be used until FSH levels remain in the postmenopausal range.
Pelvic exam in menopause
Loss of vaginal rugged leaving smooth walls
older women, a general loss of pelvic muscle tone occurs, sometimes manifested as prolapse
uterus becomes smaller and Fibroids, if present, become less symptomatic, and can shrinking to the point where they can no longer be palpated on manual pelvic examination
ovary diminishes in size and is no longer palpable during gynaecological exam
indications for rx of menopause
1) if sx are severe enough to affect QOL
2) premature menopause (before 40)
3) surgical menopause( oophorectomy)
Dx in menopause
PREGNANCY- decreased infertility not infertile
Atrophic cystitis can mimic UTI
Hyperthyroidism
endometrial hyperplasia, or endometrial cancer -menopausal women are often exposed to unopposed estrogen for long periods, and this exposure can lead to endometrial hyperplasia, a precursor of endometrial cancer.
Speculum obs during menopause
vaginal epithelium
INITIALLY redder as the epithelial layer thins and the small capillaries below the surface become more visible
later then eventually turns pale when caps reduce in number
decrease in vaginal pH leading to a change in bacterial flora may result in pruritus and a malodorous discharge
Forms of HRT
Local: creams, pessaries, rings
Systemic: Oral drugs, implants, transdermal patches
rx for menopause
lifestyle changes
- exercise for insomnia
- acupuncture for hot flushes
- stop smoking to prevent osteoprosis
- vitamin D supplements for osteoporosis
medical therapy
-vaginal oestrogen creams/ tablets to rx ATROPHIC
VAGINAL SX
- ospemifene (Osphena),
hormone replacement therapy -estrogen only / plus progesterone -Gonadomimetics (tibolone) which contain estrogen, progestogen, and an androgen -selective estrogen receptor modifiers #TAMOXIFEN #RALOXIFEN
OTC MEDICATIONS- phytoestrogens
for vasomotor (hot flushes) #PAROXITENE- ssri, 6wks 2 work, w/draw all # venlaflexine- snri #CLONIDINE- alpha 2 agonist decreases sympathetic activity - sedation and hypotension
Why biopsy b4 HRT
uterine polyps, endometrial hyperplasia, or endometrial cancer, which becomes more prevalent during this time, must be excluded through endometrial sampling (eg, with endometrial biopsy [EMB] or dilatation and curettage [D&C]). especially B4 admin HRT
