Flashcards in Menopause Deck (85)
What is the menopause?
The end of the female reproductive life
What is the average age of menopause in the UK?
What is the perimenopause also known as?
What is the perimenopause?
The transition period before the menopause, from the reproductive stage of life to the post-menopausal years
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
How can the duration and severity of perimenopause in an individual woman be predicted?
What are the symptoms of perimenopause?
- Weight gain
- Menstrual irregularities
- Reduced fertility
Where in particular is there weight gain in perimenopause?
- Lower abdomen
What % of women stop menstruating abruptly in the menopause?
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
What hormonal changes is the perimenopause initially characterised by?
Elevation of FSH and decreased inhibit levels, but normal levels of estradiol-17ß and LH
Are the hormonal changes in the perimenopause the same in every woman?
No, there is wide individual variation
What is the menopause defined as?
Cessation of menstrual cycles, where no more follicles develop
What is the result of the absence of follicular development in the menopause?
The ovary produces almost no oestrogen
What is the bodies primary source of oestrogen after the menopause?
Peripheral conversion of androgens
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
What other hormonal changes are there during the menopause?
- 10-20x increase in FSH
- 3x increase in LH
- Increased androgens
When does the increase in LH caused by menopause peak?
1-3 years after menopause
Why is there increased androgens in the menopause
Because elevated gonadotrophin (LH and FSH) drive the ovarian stroma to produce androgens
How can the menopause be 'induced'?
- Surgical removal of ovaries
- Iatrogenic ablation of ovarian function by chemotherapy, radiotherapy, or treatment with GnRH analogues
How much does the experience of the menopause vary between women?
Widely. with some being debilitated and others unaffected by their symptoms
What % of women going through the menopause experience symptoms?
What proportion of women going through the menopause have severe symptoms?
What are the categories of symptoms of menopause?
What are the systemic symptoms of menopause?
- Weight gain
- Heavy night sweats
What are the psychological symptoms of menopause?
- Sleep disturbance
- Poor memory
- Inability to concentrate
- Depressive mood
- Mood swings
- Less interest in sexual activity
What are the breast symptoms of menopause?
What are the skin symptoms of menopause?
- Hot flushes
What are the joint symptoms of menopause?
What are the menstrual symptoms of menopause?
- Shorter or longer between cycles
- Bleeding between periods
What are the urinary symptoms of menopause?
What are the vaginal symptoms of menopause?
- Painful intercourse
What are the other symptoms of menopause?
- Back pain
What % of women going through the menopause experience hot flushes?
Describe a hot flush
They occur with a red flush starting on the face and spreading down to the neck and chest
What are hot flushes associated with?
Peripheral vasodilation and a transient rise in body temperature
What is the mechanism of hot flushes?
Exact mechanism is unknown, but thought to be due to pulsatile LH release influencing central temperature control
Why are there urogenital changes in the menopause?
Because the uterus, vagina, bladder, and urethra are all affected by the reduction in oestrogen
What happens to the uterus after menopause?
Thinning of myometrium
What happens to vagina after menopause?
Marked atrophy of vagina, and thinning of vaginal walls with dryness
What can the thinning of vaginal walls and dryness result in?
What effect does the reduction in circulating oestrogen have on the bladder and urethra?
What does atrophy of the bladder and urethra in the menopause cause?
Symptoms of urinary incontinence and increase in UTIs
Why is oestrogen important for bones?
Protects bone mass and density
How does oestrogen protect bone mass and density?
By reducing the activity of oestoclasts
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
Where in particular is there an increased frequency of fractures after the menopause?
What is the effect of oestrogen on heart disease?
Protective effect against heart disease
How does oestrogen have a protective effect against heart disease?
Reduces levels of LDL cholesterol and raises HDL
What happens to the risk of heart disease after menopause?
Women experience the same frequency of cardiovascular disease as men
How is a diagnosis of menopause made?
Usually obvious from clinical picture
When might it be harder to diagnose menopause?
In younger women in the early stages of menopause
What needs to be considered in younger women presenting with suspected menopause?
Other causes of secondary amenorrhoea, e.g. pregnancy and hypogonadotrophic hypogonadism
What other conditions can cause similar symptoms to menopause?
- Thyroid disease
Are investigations recommended in the diagnosis of menopause?
What investigations may be undertaken in some women with suspected menopause?
- FSH levels
- Blood glucose
- Blood cholesterol and triglycerides
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
When should blood cholesterol and triglycerides be considered to diagnose menopause?
If woman has cardiovascular risk factors
What is involved in the management of menopause?
- Healthy lifestyle
- Hormone replacement therapy
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
What is HRT an effective treatment for?
The typical menopausal symptoms
What long-term problems associated with menopause can HRT have a positive influence on?
- Risk of osteoporosis
- Cardiovascular disease
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
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
What is the most effective treatment for vasomotor symptoms associated with menopause?
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
How can HRT improve quality of life?
Improve sleep, muscle aches and pains, and quality of life in symptomatic women
What urogenital symptoms can be improved by HRT?
- Vaginal dryness
- Sexual function
- Vaginal atrophy and related symptoms
- Urinary frequency
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
What are the risks of HRT?
- Thromboembolic disease (VTE and PE)
- Breast cancer
- Endometrial cancer
What kind of HRT increases the risk of thromboembolic disease the most?
What else increases the risk of thromboembolic disease on HRT?
- Previous thromboembolic disease
What kind of stroke is at increased risk with HRT?
What kind of HRT increases the risk of stroke?
What things are comparable to HRT in terms of increasing the risk of breast cancer?
- Drinking 2-3 units alcohol/day
- Being overweight/obese
What happens to the risk of breast cancer after stopping HRT?
It returns to that of a non-user
Is there an increased risk of dying of breast cancer caused by HRT?
Describe the link between HRT and endometrial cancer
Oestrogen-only HRT substantially increases the risk of endometrial cancer in a woman with a uterus
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
What are the modes of administration of HRT?
- Continuous or cyclical oral therapy
- Creams or gels
- Nasal sprays
- Local devices, e.g. progesterone releasing IUS
- Oestrogen-releasing vaginal ring
What side effects can oestrogen-containing HRT cause?
- Breast tenderness
- Leg cramps
What side effects can progesterone-containing HRT cause?
- Premenstrual syndrome-like symptoms
- Breast tenderness
- Pelvic pain
What side effects can oestrogen or progesterone containing HRT cause?
How can low mood which arises as a result of the menopause be managed?