L12 Menopause and hormone replacement therapy

Perimenopause
• Transition period – hormonal and biological changes begin to occur.
• ❌ years prior to menopause, ❌ menstrual cycles and decrease in cycle ❌.
• Physical ❌ begin during this period.

Menopause
• Permanent cessation of menses (periods) following loss of ❌ function.
(•Lower ovarian follicular function, ❌ oestrogen and progesterone produced = FSH and LH concentrations ❌)
• Diagnosis – amenorrhea for ❌ consecutive months.
• Occurs typically between ages of 40 and 58 years, median age = ❌ years

Vasomotor symptoms such as hot flushes and night sweats are possibly due to reduced hormones increasing the hypothalamus’ ❌ to changes in a body temperature.(❌ increase in body temperature can result in a hot flush.) Common (≈❌%), but not all women get these, and they vary in ❌. Overtime, hot flushes diminish and then disappear completely. Median duration ❌ years.

Drug treatments:
1. Different forms of oestrogen: Oestradiol can be given ❌ as micronized oestradiol, oestradiol valerate, estrone, estriol or conjugated equine oestrogen.
• ❌ vaginal administration is used for localised symptoms
2. Progesterone: (combined with oestrogen)
• Levonorgestrel- releasing intrauterine system (❌)
3. ❌ – selective oestrogen receptor modulator (SERM) can be used if progesterone is unsuitable.
4. ❌ – synthetic steroid - has weak oestrogen, androgen and progesterone actions – can be used as HRT.

Premature menopausal women:
• Have ❌ onset CVD episodes and osteoporosis.
• Have ❌ breast cancer risk cf. menstruating peers.
• Are strongly advised to consider HRT until age of ❌

Adverse effects of HRT
• Irregular ❌ with combined regimens
• Nausea and breast ❌
• These adverse effects ❌ decrease over time, if not lowering dose of HRT may be needed.

Topical vaginal oestrogen treatment:
• Use for urogenital symptoms
• Vaginal ❌, soreness, dyspareunia (painful sexual intercourse) and ❌ urinary frequency and urgency.
• Occurs in around ❌% of women after menopause.
• Response may take several ❌
• Systemic absorption is low, hence concurrent progesterone is ❌ required in women with a uterus.