L12 Menopause and hormone replacement therapy

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

Select ALL the COMMON symptoms of menopause.

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.

Lowest dose for the shortest duration is the general guideline for HRT.

Which of these conditions would not have increased risk for the patient on HRT?

Addition of progesterone to estrogen HRT is needed if woman has a uterus, to prevent endometrial hyperplasia and increased cancer risk.

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.

Premature menopause is:

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]

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.

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.