Menopause Flashcards Preview

B - Gynaecology > Menopause > Flashcards

Flashcards in Menopause Deck (85)
1

What is the menopause?

The end of the female reproductive life

2

What is the average age of menopause in the UK?

51

3

What is the perimenopause also known as?

The climacteric

4

What is the perimenopause?

The transition period before the menopause, from the reproductive stage of life to the post-menopausal years

5

At what age can signs and effects of the perimenopause begin?

Can be as early as 35, but most women don't become aware of them until about 10 years later

6

How can the duration and severity of perimenopause in an individual woman be predicted?

It can't

7

What are the symptoms of perimenopause?

- Weight gain
- Menstrual irregularities
- Reduced fertility

8

Where in particular is there weight gain in perimenopause?

- Lower abdomen
- Buttocks
- Thighs

9

What % of women stop menstruating abruptly in the menopause?

10%

10

What happens to menstruation in the vast majority of women in the menopause?

They experience 4-5 years of varying cycle length due to progressive ovarian failure

11

What hormonal changes is the perimenopause initially characterised by?

Elevation of FSH and decreased inhibit levels, but normal levels of estradiol-17ß and LH

12

Are the hormonal changes in the perimenopause the same in every woman?

No, there is wide individual variation

13

What is the menopause defined as?

Cessation of menstrual cycles, where no more follicles develop

14

What is the result of the absence of follicular development in the menopause?

The ovary produces almost no oestrogen

15

What is the bodies primary source of oestrogen after the menopause?

Peripheral conversion of androgens

16

What is the importance of the lack of oestrogen following the menopause?

It is the lack of oestrogen that produces most of the symptoms of menopause

17

What other hormonal changes are there during the menopause?

- 10-20x increase in FSH
- 3x increase in LH
- Increased androgens

18

When does the increase in LH caused by menopause peak?

1-3 years after menopause

19

Why is there increased androgens in the menopause

Because elevated gonadotrophin (LH and FSH) drive the ovarian stroma to produce androgens

20

How can the menopause be 'induced'?

- Surgical removal of ovaries
- Iatrogenic ablation of ovarian function by chemotherapy, radiotherapy, or treatment with GnRH analogues

21

How much does the experience of the menopause vary between women?

Widely. with some being debilitated and others unaffected by their symptoms

22

What % of women going through the menopause experience symptoms?

Around 80%

23

What proportion of women going through the menopause have severe symptoms?

1/4

24

What are the categories of symptoms of menopause?

- Systemic
- Psychological
- Breast
- Skin
- Joint
- Menstrual
- Vaginal
- Other

25

What are the systemic symptoms of menopause?

- Weight gain
- Heavy night sweats

26

What are the psychological symptoms of menopause?

- Dizziness
- Sleep disturbance
- Anxiety
- Poor memory
- Inability to concentrate
- Depressive mood
- Irritability
- Mood swings
- Less interest in sexual activity

27

What are the breast symptoms of menopause?

- Enlargement
- Pain

28

What are the skin symptoms of menopause?

- Hot flushes
- Dryness
- Itching
- Thinning
- Tingling

29

What are the joint symptoms of menopause?

- Soreness
- Stiffness

30

What are the menstrual symptoms of menopause?

- Shorter or longer between cycles
- Bleeding between periods

31

What are the urinary symptoms of menopause?

- Incontinence
- Urgency

32

What are the vaginal symptoms of menopause?

- Dryness
- Painful intercourse

33

What are the other symptoms of menopause?

- Headache
- Palpitations
- Back pain

34

What % of women going through the menopause experience hot flushes?

75%

35

Describe a hot flush

They occur with a red flush starting on the face and spreading down to the neck and chest

36

What are hot flushes associated with?

Peripheral vasodilation and a transient rise in body temperature

37

What is the mechanism of hot flushes?

Exact mechanism is unknown, but thought to be due to pulsatile LH release influencing central temperature control

38

Why are there urogenital changes in the menopause?

Because the uterus, vagina, bladder, and urethra are all affected by the reduction in oestrogen

39

What happens to the uterus after menopause?

Thinning of myometrium

40

What happens to vagina after menopause?

Marked atrophy of vagina, and thinning of vaginal walls with dryness

41

What can the thinning of vaginal walls and dryness result in?

Dyspareunia

42

What effect does the reduction in circulating oestrogen have on the bladder and urethra?

Atrophy

43

What does atrophy of the bladder and urethra in the menopause cause?

Symptoms of urinary incontinence and increase in UTIs

44

Why is oestrogen important for bones?

Protects bone mass and density

45

How does oestrogen protect bone mass and density?

By reducing the activity of oestoclasts

46

What is the effect of the drop in oestrogen in bones?

Tips the balance of oestoblast to osteoclast activity, and there is an increase in bone reabsorption resulting in an acceleration of age-related loss of bone density and increased frequency in fractures

47

Where in particular is there an increased frequency of fractures after the menopause?

- Wrist
- Hip

48

What is the effect of oestrogen on heart disease?

Protective effect against heart disease

49

How does oestrogen have a protective effect against heart disease?

Reduces levels of LDL cholesterol and raises HDL

50

What happens to the risk of heart disease after menopause?

Women experience the same frequency of cardiovascular disease as men

51

How is a diagnosis of menopause made?

Usually obvious from clinical picture

52

When might it be harder to diagnose menopause?

In younger women in the early stages of menopause

53

What needs to be considered in younger women presenting with suspected menopause?

Other causes of secondary amenorrhoea, e.g. pregnancy and hypogonadotrophic hypogonadism

54

What other conditions can cause similar symptoms to menopause?

- Diabetes
- Thyroid disease

55

Are investigations recommended in the diagnosis of menopause?

Not usually

56

What investigations may be undertaken in some women with suspected menopause?

- FSH levels
- TFT
- Blood glucose
- Blood cholesterol and triglycerides

57

When should FSH levels be considered in suspected menopause?

- To diagnose menopause in women 40-45 with menopausal symptoms
- In women aged under 40 in whom POI is suspected

58

When should blood cholesterol and triglycerides be considered to diagnose menopause?

If woman has cardiovascular risk factors

59

What is involved in the management of menopause?

- Healthy lifestyle
- Hormone replacement therapy

60

What should a healthy lifestyle include in the management of menopause?

- Stopping smoking
- Losing weight
- Limiting alcohol
- Taking regular aerobic exercise
- Ensure they have adequate calcium intake

61

What is HRT an effective treatment for?

The typical menopausal symptoms

62

What long-term problems associated with menopause can HRT have a positive influence on?

- Risk of osteoporosis
- Cardiovascular disease
- Stroke

63

What are the indications for the use of HRT?

- Treatment of menopausal symptoms when risk:benefit ratio is favourable, in fully informed women
- Women with early menopause, until age of natural menopause (around 51), even if asymptomatic
- Women under 60 who are at risk of osteoporotic fractures, and in whom non-oestrogen treatments are not suitable

64

What are the benefits of HRT?

- Reduction in vasomotor symptoms
- Improvement in quality of life
- Improvement in mood changes
- Improvement of urogenital symptoms
- Reduction in osteoporosis risk
- Reduction in cardiovascular disease
- Lower risk of colorectal cancer

65

What is the most effective treatment for vasomotor symptoms associated with menopause?

HRT

66

How long does it take for benefit to be achieved in vasomotor symptoms using HRT?

Usually improved within 4 weeks of starting treatment, and maximal benefit gained by 3 months

67

How can HRT improve quality of life?

Improve sleep, muscle aches and pains, and quality of life in symptomatic women

68

What urogenital symptoms can be improved by HRT?

- Vaginal dryness
- Sexual function
- Vaginal atrophy and related symptoms
- Urinary frequency

69

Describe the role of HRT in reducing osteoporosis risk?

It is the first line treatment for prevention and management of osteoporosis in women with menopausal symptoms under 50, significantly decreasing the incidence of fractures with long-term use

70

What are the risks of HRT?

- Thromboembolic disease (VTE and PE)
- Stroke
- Breast cancer
- Endometrial cancer

71

What kind of HRT increases the risk of thromboembolic disease the most?

Oral

72

What else increases the risk of thromboembolic disease on HRT?

- Age
- Obesity
- Previous thromboembolic disease
- Smoking

73

What kind of stroke is at increased risk with HRT?

Ischaemic

74

What kind of HRT increases the risk of stroke?

Oral

75

What things are comparable to HRT in terms of increasing the risk of breast cancer?

- Drinking 2-3 units alcohol/day
- Being overweight/obese

76

What happens to the risk of breast cancer after stopping HRT?

It returns to that of a non-user

77

Is there an increased risk of dying of breast cancer caused by HRT?

No

78

Describe the link between HRT and endometrial cancer

Oestrogen-only HRT substantially increases the risk of endometrial cancer in a woman with a uterus

79

How can the risk of endometrial cancer caused by HRT be reduced?

Use of cyclical progesterone for at least 10 days per 28 day cycle

80

What are the modes of administration of HRT?

- Continuous or cyclical oral therapy
- Patches
- Creams or gels
- Nasal sprays
- Local devices, e.g. progesterone releasing IUS
- Oestrogen-releasing vaginal ring

81

What side effects can oestrogen-containing HRT cause?

- Breast tenderness
- Leg cramps
- Bloating
- Nausea
- Headaches

82

What side effects can progesterone-containing HRT cause?

- Premenstrual syndrome-like symptoms
- Breast tenderness
- Backache
- Depression
- Pelvic pain

83

What side effects can oestrogen or progesterone containing HRT cause?

Bleeding

84

How can low mood which arises as a result of the menopause be managed?

- HRT
- CBT

85

Do antidepressants help in low mood caused by the menopause?

No evidence for this