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Perimenopause
• Transition period – hormonal and biological changes begin to occur.
• [blank_start]2 to 8[blank_end] years prior to menopause, [blank_start]irregular[blank_end] menstrual cycles and decrease in cycle [blank_start]length[blank_end].
• Physical [blank_start]symptoms[blank_end] begin during this period.
Menopause
• Permanent cessation of menses (periods) following loss of [blank_start]ovarian follicular[blank_end] function.
(•Lower ovarian follicular function, [blank_start]less[blank_end] oestrogen and progesterone produced = FSH and LH concentrations [blank_start]increase[blank_end])
• Diagnosis – amenorrhea for [blank_start]12[blank_end] consecutive months.
• Occurs typically between ages of 40 and 58 years, median age = [blank_start]52[blank_end] years
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2 to 8
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irregular
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length
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symptoms
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ovarian follicular
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less
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increase
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12
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52
Frage 2
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Select ALL the COMMON symptoms of menopause.
Frage 3
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Vasomotor symptoms such as hot flushes and night sweats are possibly due to reduced hormones increasing the hypothalamus’ [blank_start]sensitivity[blank_end] to changes in a body temperature.([blank_start]Small[blank_end] increase in body temperature can result in a hot flush.) Common (≈[blank_start]70[blank_end]%), but not all women get these, and they vary in [blank_start]severity[blank_end]. Overtime, hot flushes diminish and then disappear completely. Median duration [blank_start]5.2[blank_end] years.
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sensitivity
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Small
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70
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severity
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5.2
Frage 4
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Lowest dose for the shortest duration is the general guideline for HRT.
Frage 5
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Which of these conditions would not have increased risk for the patient on HRT?
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Breast cancer
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Endometrial cancer
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Ovarian cancer
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VTE
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Stroke
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CHD
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Colon cancer
Frage 6
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Addition of progesterone to estrogen HRT is needed if woman has a uterus, to prevent endometrial hyperplasia and increased cancer risk.
Frage 7
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Drug treatments:
1. Different forms of oestrogen: Oestradiol can be given [blank_start]orally[blank_end] as micronized oestradiol, oestradiol valerate, estrone, estriol or conjugated equine oestrogen.
• [blank_start]Topical[blank_end] vaginal administration is used for localised symptoms
2. Progesterone: (combined with oestrogen)
• Levonorgestrel- releasing intrauterine system ([blank_start]Mirena[blank_end])
3. [blank_start]Bazedoxifene[blank_end] – selective oestrogen receptor modulator (SERM) can be used if progesterone is unsuitable.
4. [blank_start]Tibolone[blank_end] – synthetic steroid - has weak oestrogen, androgen and progesterone actions – can be used as HRT.
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orally
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Topical
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Mirena
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Bazedoxifene
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Tibolone
Frage 8
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Premature menopause is:
Frage 9
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Premature menopausal women:
• Have [blank_start]earlier[blank_end] onset CVD episodes and osteoporosis.
• Have [blank_start]reduced[blank_end] breast cancer risk cf. menstruating peers.
• Are strongly advised to consider HRT until age of [blank_start]50[blank_end]
Frage 10
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Adverse effects of HRT
• Irregular [blank_start]bleeding[blank_end] with combined regimens
• Nausea and breast [blank_start]tenderness[blank_end]
• These adverse effects [blank_start]usually[blank_end] decrease over time, if not lowering dose of HRT may be needed.
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bleeding
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tenderness
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usually
Frage 11
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Topical vaginal oestrogen treatment:
• Use for urogenital symptoms
• Vaginal [blank_start]dryness[blank_end], soreness, dyspareunia (painful sexual intercourse) and [blank_start]increased[blank_end] urinary frequency and urgency.
• Occurs in around [blank_start]50[blank_end]% of women after menopause.
• Response may take several [blank_start]months[blank_end]
• Systemic absorption is low, hence concurrent progesterone is [blank_start]not[blank_end] required in women with a uterus.
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dryness
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increased
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50
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months
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not