Menopause - Gynaecology

Menopause

·        Up to last period and 2 years following

·        Primary ovarian failure ® ¯ oestrogen feedback ® ­­FSH

·        Continue contraception for one year following last period (eg PoP, IUCD, condoms)

·        Usually age 50 – 51. Cycles start to slow from 47 – 48. Usually follows pattern of her mother. Factors affecting age:

o  CoC delays menopause (lots of eggs left over)

o  Earlier if chronic disease or toxins (eg radiation, chemo, etc)

·        Signs:

o  Hot flushes, palpitations

o  Night sweats

o  Mood swings/depression 

o  Vaginal atrophy ® dyspareunia, post-coital bleeding

o  Urinary frequency/incontinence

·        Test for high TSH if wanting to exclude thyroid and psychiatric problems

Hormone Replacement Therapy

·        Replacing normal physiological dose of oestrogen (cf CoC which is much higher)

·        Contraindications:

o  History of breast or endometrial cancer (not ovarian or cervical)

o  Undiagnosed vaginal bleeding

o  Liver disease (it‟s metabolised in the liver)

o  Pregnancy or breast-feeding!

o  Past PE 

o  High cholesterol is NOT a contra-indication – it‟s protective (compared with OC dose of progesterone which is bad)

o  Smoking is NOT a contra-indication – it‟s protective

o  DVT is NOT a contra-indication (whereas OC dose of oestrogen is bad for clots)

·        Benefits:

o  Especially good for those with hysterectomy, bilateral oophorectomy, ­risk of osteoporosis, IHD, ­cholesterol, DM, RA

o  Oestrogen effects: ¯menopause symptoms, ¯ osteoporosis, ¯ CV disease (¯LDL, ­HDL, vasodilates coronary arteries)

o  Progesterone effects: ¯risk of endometrial cancer (if they have a uterus) by preventing proliferation of endometrium by unopposed oestrogen

o  ??Protective against colon cancer and Alzheimer‟s

·        Side-effects: ­weight, PMS, cholestasis, vomiting

·        Risks:

o  Minimal breast and ovarian cancer risk if taken for less than 5 years

o  Gallbladder disease

o  If severe heart disease then slightly ­ risk of CV problems in 1^st years

·        Types:

o   Cyclical: continuous oestrogen, progesterone for any 10 days per cycle (with bleeding 2 – 3 days after its finished). Good if immediately post-menopausal – cycle them for a while and if no break through bleeding then ® continuous HRT after a year

o   Non-cyclical: Continuous oestrogen and progesterone. No period as oestrogen and progesterone oppose each other ® stable endothelium. Don‟t start until after menopause. Ovary may still be „surging‟ from time to time ® break through bleeding that you‟ve got to investigate