Flashcards in MENOPAUSE Deck (27)
What is the strict diagnostic definition of the menopause?
Retrospective diagnosis after 1 year of absent cycles.
What age do women tend to go through the menopause?
45-55 years old
Average is 51
What do we call a premature menopause?
Less than 40 years old
Why can women experience symptoms of heavy bleeding and irregular periods in the perimenopausal phase?
Anovulatory (where no ovulation occurs) cycles become more common and oestrogen secretion can continue without progesterone opposition required to protect the endometrium. These patients are at risk of endometrial hyperplasia and rarely endometrial cancer.
What are the hormonal changes in the menopause?
What are the more immediate clinical features of the menopause?
Hot flushes and night sweats
Mood disturbances - mood swings, insomnia, anxiety, fatigue, loss of libido, loss of concentration
What are the intermediate and long term features and complications associated with the menopause?
Atrophy of vaginal tissue - dryness, dyspareunia and vaginal bleeding
Atrophy of urethra - dysuria, frequency and urge incontinence
Cardiovascular disease - gender equal likelihood by 70
It is still possible to get pregnant in the climacteric or perimenopausal phase?
Yes, therefore patients should continue to be offered contraception.
What blood test might you do to confirm the menopause?
Serum FSH levels will show markedly raised concentrations.
What are the conservative and medical options to help someone who has been through the menopause?
Regular aerobic exercise will help bone loss and improve muscle tone
Cessation of smoking and alcohol
Hormone replacement therapy
Non-hormonal pharmacological agents such as clonidine and SSRIs
What is the hormone given to postmenopausal women as part of HRT?
Oestrogen and progesterone
Oestrogen alone is given to patients who have had a hysterectomy, as progesterone is no longer required tpo protect the endometrium
Prior to the menopause, what is the main type of oestrogen circulating the body?
Where is oestradiol produced?
In the granulosa cells of the developing follicle
Following the menopause, what is the main type of oestrogen circulating the body and where is it produced?
Oestrone produced in the peripheral tissues
What form of oestrogen is given as part of HRT?
What are the different routes for administering HRT?
Over what maximum period of time should cyclical preparations of HRT, which are therefore accompanied by monthly bleeding, be administered to a post-menopausal woman?
What are the advantages and disadvantages of oral HRT?
First pass metabolism
Variable plasma levels
Higher doses required
What are the advantages and disadvantages of transdermal HRT?
Avoids first pass metabolism
Reduced risk of VTE
What are the advantages and disadvantages of vaginally administered HRT?
Good for urogenital symptoms
Minimal systemic absorption
Licensed for 3 months use without progesterone opposition
Unlikely to treat other symptoms
What are the advantages and disadvantages of Mirena coil HRT?
Licensed for 4 years to provide the progesterone arm of HRT
Contraceptive in perimenopausal phase
Only provides progesterones
What are the side effects of HRT?
What are the risks of taking HRT?
What are the contraindications to the use of HRT in the menopause?
Undiagnosed vaginal bleeding
Undiagnosed breast lumps
Severe active liver disease
Personal history of VTE - transdermal may be used
If hormonal agents are not tolerated or contraindicated in someone needing medical management to control the symptoms of menopause, what medications can be given?
Clonidine - centrally active alpha-2 agonist
Who should be considered for HRT in the menopause?
HRT should only be considered for those with severe symptoms.
It is also recommended for those under the age of 50 undergoing menopause for bone protection. This should be reviewed at 51.