Menopause Flashcards
(21 cards)
What is menopause
Permanent Cessation of Menstruation due to loss of Ovarian Follicular activity
o Recognised to have occurred after 12 consecutive months of Amenorrhoea without obvious pathological or physiological cause
o In late 40yrs, FSH initially then LH concentrations rise as Follicular supply diminishes; Oestrogen
levels fall, resulting in Cycle Variability
Perimenopause
Begins with first Clinical, Biological and Endocrine features of approaching Menopause (e.g. Vasomotor symptoms, Menstrual Irregularity
Menopausal Transition
Time prior to Final Menstrual Period, with increased cycle variability
Climacteric
Transitioning from Reproductive to Non-Reproductive state
Diagnosing/Confirming Menopause
FSH is helpful only if diagnosis is in doubt; LH, Oestradiol and Progesterone of no value for diagnosis of Ovarian failure
o TFTs to rule out; Thyroid disease can present similar to Menopausal symptoms
Vasomotor Symptoms
Hot flushes and Night Sweats are common; Highest prevalence in first year; Typically settles after <5yrs
Sexual Dysfunction
Multifactoral; Vaginal Dryness due to Oestrogen deficiency, Unknown if lower Androgen levels plays role
o Psychosocial Factors – Conflict, Life Stress, Depression; Male Sexual problems
o Classified based on Loss of Desire, Arousal, Orgasm or Dyspareunia
Psychological Symptoms
Depression, Anxiety, Irritability and Mood Swings, Lethargy, Sleep disturbance, Loss of Concentration, Weight gain
Most women do not experience major changes; Psychological issues likely associated with other problems and life stressors
Osteoporosis
Compromised Bone Strength predisposing to increased risk of fracture
o Rapid loss in Bone Density in 10yrs after; Reduced BMD and poorer Bone Quality
o Most common sites of Osteoporotic fractures are Colle’s, NOF, and Vertebral
o Additional Risk Factors include FH, Low BMI, Early Menopause, Smoking, ETOH, Low Calcium, Sedentary Lifestyle, Corticosteroid use (>5mg Pred daily), Aromatase Inhibitors, GnRH Analogues, Hyperthyroid and Parathyroid, Malabsorption
Cardiovascular Risks
Higher risk of MI and Stroke
Urogenital Atrophy
Oestrogen deficiency leads to atrophic changes; Frequency, Urgency, Nocturia, Incontinence and Recurrent Infection
May co-exist with Vaginal Atrophy – Dyspareunia, Itching, Burning, Dryness
Premature Ovarian Failure
Loss of Ovarian Function before 40yrs; Triad of Amenorrhoea, Hypergonadotrophism (Loss of Negative Feedback raises FSH) and Low Oestrogen
o Associated with Hypothyroidism, Addison’s Disease and other Autoimmune
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o If occurs prior to Menarche = Primary Ovarian Failure
Causes of POF
Mostly Idiopathic – Primary causes include Chromosomal Abnormalities, FSH receptor mutations, Inhibin B mutations, Enzyme deficiencies and Autoimmune
o Can also be secondary to Chemo, Radiotherapy, Oophorectomy, Hysterectomy (Reduced blood flow to Ovaries?), Infection
Treating POF
Require Oestrogen Replacement until average age of Natural Menopause; HRT or back-to-back COCP; No evidence for Bisphosphonates and Bone protection
How can HRT be given?
Can be given either Systemically (for Hot flushes and Osteoporosis) or Vaginally (for Local Symptoms like Vaginal Dryness)
HRT for women without hysterectomy
Combined HRT is recommended (Mitigates risk of Endometrial Cancer from unopposed Oestrogen)
Types of HRT available
Oestrogens – Oestradiol, Oestrone, Oestriol synthesized from plants but chemically similar
• Progestagens – Dydrogesterone, Medroxyprogesterone Acetate, Norethisterone, Levonorgestrel derived from Plant sources
Local HRT
Cream or Pessaries/Rings; Long term treatment required; No Endometrial effects from using unopposed Oestrogens in Non-Hysterectomised women
Alternatives to HRT
Alternatives to HRT for Symptomatic Relief – SSRI (Fluoxetine, Paroxetine) and SNRI (Venlafaxine) for Vasomotor Symptoms; Bone Protection and SERMS for Osteoporosis
Benefits of HRT
Reduced Vasomotor symptoms, Urogenital symptoms, Sexuality, Reduced risk of Osteoporosis and Colorectal Ca
HRT Risks
Increased risk of Ca Breast, Endometrial Ca, VTE; Unknown if increases Gallbladder Disease
Unopposed Oestrogen raises Endometrial Ca risk by RR2.3; Further to 9.5 if >10yrs use; Remains for >5yrs after stop; No increased risk with Continuous Combined HRT
o Increased VTE risk; Absolute risk remains small; More likely in first year of HRT
▪ Age, Obesity, Thrombophilia significantly increases risk
Breast Cancer – Similar risk to Late Natural Menopause; Dependent on Duration; Risk to baseline once HRT stopped; Dependent on regimen (Combined HRT > Unopposed)
