Menopause Flashcards
(17 cards)
What does menopause mean?
Last ever period
What is the average age of menopause?
51
How long does perimenopause occur for?
approx. 5 years before menopause
At what age is menopause considered premature?
40 or under
What is the physiology behind menopause?
Ovarian insufficiency
- oestradiol falls
- FSH rises
- Still some oestradiol from peripheral conversion of adrenal androgens in fat
What are some symptoms of menopause?
Vasomotor symptoms (hot flushes) Vaginal dryness / dyspareunia Low libido Muscle and joint aches Mood changes Poor memory
How can you prevent and treat menopausal osteoporosis?
Exercise Adequate calcium and vitamin D HRT Bisphosphonates Denosumab (monoclonal antibody to osteoclasts) Teriparatide (PTH replacement)
What are the different options for symptomatic treatment of menopause?
Systemic HRT Local HRT selective oestrogen receptor modulators (SERMs) SSRI/SNRI antidepressants Natural methods Non hormonal vaginal lubricants
What is the benefit of using a transdermal hormonal patch over gel or oral preparations?
Avoids first pass metabolism, less VTE risk
If the patient has had a hysterectomy, which hormones do they need?
Oestrogen only
If the patient still has their uterus, which hormones do they need?
Progestogen to prevent endometrial hyperplasia, as well as oestrogen
What are the advantages of local HRT, i.e. vaginal pessary/ring/cream?
Minimal absorption - no increased VTE or breast cancer risk
Don’t need progestogen for endometrial protection
What are the contraindications to systemic HRT, and when should you seek advice?
contrindications:
- current hormone dependent breast/endometrial cancer
- current active liver disease
- uninvestigated abnormal bleeding
seek advice if:
- previous VTE, thrombophilia, FH VTE
- previous breast cancer or BRCA carrier
What is first line treatment for osteoporosis?
Bisphosphonates
Jane is 48 and has hot flushes and night sweats. She has periods 5/30 cycle but has missed 2 periods in the last year. Which HRT should you recommend?
Vasomotor symptoms need oestrogen
Has a uterus so needs progestogen
Has some ovarian function so needs: Cyclical combined OR
Mirena + oestrogen oral/transdermal
Sheila had a hysterectomy for menorrhagia when she was 36 for 18/40 size fibroids. Her ovaries were conserved. She is now 39 and has hot flushes - she wonders if she is menopausal. Which HRT would you recommend?
Premature menopause is frequent after hysterectomy even if ovaries are conserved
If symptomatic, needs oestrogen
Does not have uterus so does not need progestogen
Maybe vaginal HRT for vaginal symptoms
Lucy is 55. Her periods stopped when she was 51. She attends for routine cervical cytology - which is more uncomfortable than before and mentions that she has vaginal dryness and dyspareunia. She has tried non hormonal vaginal moisturisers and lubricants but still has symptoms. Which HRT would you recommend?
If significant atrophy is likely to need oestrogen
Has uterus and is >2 years postmenopausal
Vaginal oestrogen - pessary/ring/cream
