What is the average age of the menopause in the UK?
511
Early menopause occurs between what ages?
40-44 (5%)
Premature ovarian insufficiency occurs in what ages?
Less than 40
What is the average durations of menopause symptoms and how many do women usually get?
- usually lasts around 7.4 years
- average number of symptoms is 7
Most menopause symptoms improve over time except what?
Genitourinary problems (dry vagina, painful sex, urinary symptoms etc)
What is menpause?
- cessation of menstrual cycle due to loss of ovarian function
- after one year of amenorrhoea
Name some symptoms of menopause
- mood swings
- night sweats
- hot flushes
- anxiety
- dizziness
- depression
- irritability
- painful sex
- headaches
- loss of sex drive
- lack of energy
- recurrent UTI symptoms
- palpitations
- aches and pains
- brain fog
- dry skin and hair
- memory loss
Describe the diagnosis of peri-menopause
FSH levels x2 (6 weeks apart) indicated;
- in women >45 with atypical symptoms
- in women between 40 and 45 with menopausal symptoms a/o iatrogenic amenorrhoea (TAH, endometrial ablation etc)
FSH, E2, TFT, glucose, prolactin and FAI should be checked;
- in women <40
- check also chromosomes and exclude autoimmune disorders in women <35
What is the free androgen index formula?
FAI = total testosterone (nmol/L) x 100 / sex hormone binding globulin (SHBG) (nmol/L)
Name some non-hormonal treatments of menopausal symptoms
- herbal medicine; st johns wort, black kohosh, sage etc
- non-hormonal medical treatments; antidepressants, gabapentin
- complementary medicine; acupuncture, homeopathy, aromatherapy, hypnotherapy, acupressure
What are the risks and benefits of HRT?
Benefits; - symptoms relief - increased quality of life - increased mental health - increased sexual health - decreased osteoporosis - decreased cardiovascular disease - reduction of vasomotor symptoms Risks; - increased breast cancer risk - increased VTE risk - increased CVD risk (>60)
What are some contraindications to HRT?
- history of breast cancer
- coronary heart disease
- transient ischaemic attack or previous stroke
- unexplained vaginal bleeding
- active liver disease
What is the first line treatment for vasomotor symptoms and low mood / anxiety in menopause?
HRT
Name indications for transdermal HRT
- individual preference
- poor symptom control with oral HRT
- GI disorder affecting oral absorption
- increased VTE risk; BMI >30, FHx etc
- variable blood pressure control
- migraine
- current use of hepatic inducing enzyme medication
- gall bladder disease
Describe contraceptive use in perimenopausal symptoms
Age <40;
- premature insufficienncy of ovaries might be transitional, continue with contraception
Age 40-49;
- contraception can be stopped if
- 2 years after last natural menstrual period
- 2 years after 2 results of FSH >30 IU/L taken at least 4-6 weeks apart
Age >50;
- contraception can be stopped if
- 1 year after last natural menstrual period
- 1 year after 1 result of FSH >30 IU/L
Age >55;
- contraception can be stopped even if still having periods due to poor oocyte quality
- might consider continuing contraception for another year or two if periods troublesome (non-contraceptive indication)
Describe the treatment of urogenital atrophy
- offer vaginal oestrogen to women with VVA (including those on systemic HRT) and continue treatment for as long as needed to relieve symptoms
- explain to women with VVA that; symptoms often come back when treatment is stopped
- vaginal oestrogen can be used alone or in addition to systemic HRT
- moisturisers and lubricants can be used alone or in addition to vaginal oestrogen
- consider vaginal oestrogen for women with VVA in whom systemic HRT is contra-indicated (except in women with a history of breast ca)
