Menopause Flashcards
Define climacteric
Time period from the onset of menopausal symptoms to 12/12 after the final menstrual period
When is menopause deemed to be complete?
12/12 after LMP
OR 6/12 after LMP with high FSH and LH on bloods
Define primary ovarian insufficiency?
Menopause occuring before 40y/o
Briefly describe the hormonal changes in menopause
Fall in oestrodiol causes the negative feedback mechanism to fail - FSH and LH rise
What is the hormonal cause of most of the symptoms of menopause?
Low oestrogen
Name the types of HRT
Combined HRT
Oestrogen only HRT
Tibolone
What are the different regimes of combined HRT?
Continuous combined - both oestrogen and progesterone taken daily
Sequential combined - oestrogen taken daily, with progesterone taken for last 10-14 days of the cycle
Long sequential combined -
oestrogen taken daily for 3/12 and progesterone taken for second half of the 3rd month
Who can take oestrogen only HRT and why?
Women who have had a hysterectomy - they do not require the endometrial protection which progesterone gives
Who should NOT be given HRT?
History of breast cancer
What is the risk associated with oestrogen only HRT?
Endometrial cancer VTE (if PO) Ischaemic stroke (if PO)
What is the risk associated with combined HRT?
Breast cancer
VTE (if PO)
Ischaemic stroke (if PO)
What are the benefits of HRT?
Improved vasomotor symptoms (less hot flushes) Improves mood Improves urinary symptoms Reduced risk of osteoporosis Cardiovascular protection
What is the red flag diagnosis with post-menopausal bleeding?
Endometrial cancer
What is the most common cause of PMB and how is it diagnosed and treated?
Vaginal atrophy
Diagnosis of exclusion following normal USS of endometrium.
Managed with reassurance, lubricants and topical oestradiol creams
What is the most important risk factor for endometrial hyperplasia?
Tamoxifen
