What is peri menopause?
Time before last menstrual period when ovarian activity slows and oestrogen levels start to fall (can last several years)
What is menopause?
The time when menstruation ceases permanently due to the loss of ovarian follicular activity. Occurs with final menstrual period diagnosed clinically after 12 months of amenorrhoea
What is post menopause?
Time after last menstrual period
What happens to the levels of oestrogen, FSH and LH?
Oestrogen levels decrease, FSH and LH rise
When does early menopause occur?
Before 45
What is premature ovarian insufficiency?
Menopause before the age of 40 years
What are the causes of early menopause?
Family history, premature ovarian failure, radiotherapy, chemotherapy, hysterectomy, infection (mumps, TB, malaria - very rare)
How to diagnose menopause?
- Over 45 with irregular periods: no tests required
- Under 45 may test FSH, if raised very likely
What are symptoms of menopause?
- Vaginal symptoms (dryness, discomfort, itching and dyspareunia)
- Hot flushes
- Night sweats
- Anxiety & depression
- Brain fog
- Insomnia
- Urinary problems
- Headaches, joint and muscle pains
What are long term physical effects of menopause?
- Thinning of skin & hair
- Bone mass lost, more prone to breaking
- Dryness of eyes, mouth & throat
- Atrophy of breasts, endometrium, vagina, vulva, pelvic muscles
What are associated problems of menopause?
- Increased risk of osteoporosis, CVD, dementia
- Breast cancer risk increases with HRT therapy
What are the treatment options for menopause?
- Lifestyle advice
- Weight management and exercise
- Wear lighter/cooler clothes
- Avoid triggers to hot flushes - caffeine, spicy foods
- Sleep hygiene
- Sleep in a cooler room
- Reduce stress
- Relaxation techniques
How to manage menopause without HRT?
- Antidepressants
- Vaginal moisturiser e.g. Replens
- Clonidine 50-75mcg BD
- Psychotherapy, counselling, homeopathy, supplements
What are the benefits of HRT?
- Treating vasomotor symptoms (night sweats and hot flushes)
- Treating urogenital symptoms (vaginal dryness)
- Managing sleep/mood disturbances
- Preventing osteoporosis
What do HRT medicines do?
Deliver a set dose of oestrogen into the bloodstream
What does oral oestrogen do?
Increases sex hormone binding globulin (SHBG) so reducing free androgen index (lowers libido even more)
If a patient has a hysterectomy what do they not require?
Progesteron
What is oestrogen best as?
17 betaestradiol
What choice of progesterone is given?
Utrogestan prescribed cyclically
> 200mg each evening for 2/4 weeks (10 days taking POP)
or 100mg each evening
What are the 4B’s (adverse effects) of progesterone?
Bloating, breast tenderness, bleeding, blues
What is the IUD Mirena?
Alternative route of delivery of progestogen to protect endometrium
Low bleed risk, safe for up to 5 years
Is vaginal oestrogen HRT and how is it used?
No, applied to the vagina for vaginal atrophy e.g. ortho gynest, vagifem pessaries
What does testosterone do when added to HRT?
Improves sexual function, general wellbeing and improves libido
What to do when stopping HRT in an emergency?
- Stop 4-6 weeks before surgery
- DVT risk
- Severe stomach pain, calf pain in one leg, neuro effects
- BP > 160/100
