The menopause Flashcards
(22 cards)
Approximately how many menstrual cycles does a woman have in a lifetime?
400
In each cycle 20-30 primordial follicles begin to mature
Perimenopause
Ovaries become less sensitive to FSH –> increased levels of FSH to compensate –> increase in number of anovulatory cycles and decreased levels of oestrodiol and progesterone
Premature menopause
Before the age of 45 (1% of women have menopause before 40)
Primary causes of premature menopause?
Chromosomal: tuner’s, fragile X
Autoimmune: Hypothyroid, Addison’s, myasthenia gravis
Enzyme def - galactosaemia
Secondary causes of premature menopause
Surgical - oophorectomy
Chemo/radiotherapy
Infections - TB, mumps, malaria, varicella
Vasomotor effects of menopause
Usually last <5 years: Hot flushes, night sweats (affect 70%) Sleep disturbance - tired, irritable, poor concentration Reduced cognitive function Mood changes
Urogenital effects of menopause
Decreased oestrogen –> vaginal atrophy and urinary problems
Bladder: frequency, urgency, dysuria, UTI
Vagina: dryness, soreness, dyspanuria
Cardiovascular effects of menopause
Risk of CHD and stroke increased (3x risk in early menopause)
Accounts for 1/3 of deaths in women
Osteoporosis in menopause
Decreased oestrogen –> increased bone resorption –> decreased bone strength –> fractures (collet, hip and spine)
Affects 1/3 women >50yrs (1/12 men)
When can solely oestrogen be given as HRT
When the woman has had a hysterectomy (no need for progesterone as there is no lining of the uterus)
Don’t use when uterus is present because there is an increased risk of endometrial cancer with unopposed oestrogen
Given orally, transdermal or S/C
First line treatment for vaginal atrophy?
Topical oestrogen
Preferred route for HRT?
Transdermal - has fewer risks than oral HRT
If still bleeding, what is the recommended regimen for HRT?
Cyclical combined HRT:
Oestrogen for 28 days
Progesterone for 14 days - causes regular bleed (like a light period with no ovulation)
If still bleeding, when can they switch to continuous combined HRT?
When they have been taking cyclical combined HRT for 1 year
or if their LMP was >1 year ago
Continuous combined HRT
Progesterone + oestrogen
Used in ‘true’ menopause (LMP > 1 year ago)
May cause irregular bleeding for 3-6months (investigate after 6 months)
Benefits of HRT?
Vasomotor: reduces hot flushes and night sweats
Urogenital: symptoms respond well to treatment but may take a few months to kick in
Osteoporosis: reduces risk of osteoporotic fractures
Colorectal Ca - risk reduced by 1/3
Risks of HRT
Increased risk of breast cancer (higher risk in combined HRT) - effect is not sustained (5 years after discontinuation there is same risk as women who have not had HRT)
Increased risk of endometrial cancer
VTE risk:
x4 in first 6 months
x3 in second 6 months
normal after 12 months
Alternatives to HRT
Lifestyle: diet, exercise
Reduce caffeine, alcohol, spicy food and stop smoking
Antidepressants - can help with hot flushes and night sweats
Clonidine - reduces hot flushes and night sweats (but not v. effective)
Tibolone
Synthetic steroid (with weak oestrogen, progestogen and andronergic effects) Treats vasomotor, psychological and libido symptoms Conserves bone mass and reduces risk of fracture
PMB
Atrophic vagintis
Endometrial polyps or hyperplasia
Endometrial carcinoma
Cervical carcinoma
What does PCB indicate with PMB?
Cervical polyp or carcinoma
TV USS for PMB
Endometrial thickness should be <3mm (<5mm if on HRT)
If thickness is >5mm then biopsy is required
Nb. unless on tamoxifen (thickens endometrium) - do hysteroscopy
