Menopause
Test your Knowledge
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Could you answer the following questions if you were asked.What is Perimenopause and how do I know if I have reached it?
What age can I stop taking birth control pills?
What medication can i take to control hot flushes?
Does herbal medication work to help ease menopausal symptom?
Can you re-assure a patient with the following concerns:
My doctor wants me to start HRT treatment but I heard it causes breast cancer.
I have a family history of osteoporosis but don't want to go on HRT what else can I take?
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Menopause in Brief
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Menopause
The menopause refers to that time when periods stop and the ovaries lose their reproductive function. Usually, this occurs between the ages of 45 and 55.
In the UK the average age is 51.
The loss of reproductive function is due to a change in the levels of the three reproductive hormones oestradiol, oestrone and oestriol, collectively known as oestrogen and are produced in the ovaries.
As women get older, the store of eggs in the ovary decreases and the ability to conceive diminishes. The reduction in egg cells levels mean that the ovaries are less able to respond to the Follicle stimulation Hormone (FSH) and luteinising hormone (LH) secreted from the pituitary gland in the brain, so consequently levels of oestrogen drop and FSL & LH levels rise.
Symptoms of menopause
hot flushes, night sweats, depression, anxiety or irritability, mood swings, insomnia, fatigue, dry skin, vaginal dryness, frequent urination
Can also increase cholesterol levels which can increase the risk of heart disease
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Premature menopause or premature ovarian insufficiency
Menopause occurring before 45 years of age is considered as early menopause and before the age of 40 is called premature menopause.
You may enter menopause earlier than normal if you:
have a family history of early menopause
are a smoker
have had a hysterectomy or oophorectomy
have undergone cancer treatments
Generally, women entering early or premature menopause are advised to undertake HRT treatment until they enter their early 50’s to help alleviate menopause symptoms and protect mineral loss from bones.
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Peri-menopause
Premenopause and perimenopause are sometimes used interchangeably, but technically, they have different meanings.
The body does not stop producing oestrogen overnight, and the process can even take several years, during which symptoms arise gradually. This gradual change is called the ‘peri-menopause’ and most women enter this stage 8 to10 years ahead of their actual menopause. As the body is still producing oestrogen, therefore egg production is still taking place, even if it is sparse, it is still possible to get pregnant, therefore contraception is still advisable.
At around the age of 50-55 years, the monthly cycle stops completely (Menopause) – so no more ovulations, no more periods and no more pregnancies
During perimenopause you may start to experience symptoms of menopause which may include: Irregular, heavier or lighter periods, worse PMS before periods, breast tenderness, weight gain, hair changes, increase in heartbeat, headache, loss of sex drive, concentration difficulties, forgetfulness, muscle aches, UTI's, fertility issues (in women who are trying to conceive).
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How do you know if you are Peri-menopause or menopausal
Most doctors will evaluate a woman’s menopausal status according to her symptoms (hot flushes, for example), pattern of periods, and medical record. It is possible to take a blood test to measure levels FSH. However, while elevated FSH levels may be a sign of the menopause, the test is not always accurate as results can be effected by other factors such as the contraceptive pill or the women’s menstrual cycle. Therefore, the measurement of FSH is not required to diagnose perimenopause or menopause in women aged over 45 years.
Women who have had a hysterectomy and, at the same time, surgical removal of the ovaries for various medical reasons will have an immediate menopause, whatever the patient’s age, and all the symptoms and risks associated with a natural menopause will apply to these women.
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Postmenopausal
This is the time following the last period, and is usually defined as more than 12 months with no periods in someone with intact ovaries, or immediately following surgery if the ovaries have been removed.
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HRT Treatment or not !!!!!
Recent reports & scare stories have convinced the public and many health-care providers that breast cancer is the greatest concern for menopausal women and that HRT is responsible. Media, air a compelling scary story, which creates an underlying distrust of science, doctors, and HRT. Then for every media report, an expert will be found with an equally conflicting view. This combined with improved breast cancer survival has overshadowed cardiovascular diseases as the major cause of death and disability in the later years. The ongoing challenge for clinicians dealing with menopausal women is to bridge the gap in risk perception with evidence-based common-sense advice.
Read more on link below.*******************************************************************************************
Risk & Benefits HRT
The two current licensed indications for prescribing HRT are: -
1) Relief of menopausal symptoms
2) Prevention / treatment of osteoporosis
Nice guidelines recommend HRT treatment for premature menopause (either natural or surgery induced) to counter the increase risk of osteoporosis and symptoms of menopause. Treatment should be continued until natural age of menopause (50’s). If the main concern is osteoporosis, not symptoms of HRT, than other medication can be considered. See above link to NICE guidelines.
Symptomatic Relief
HRT is very effective at reducing menopausal symptoms (70-80%). HRT should be started under the age of 60 and reviewed every 2-3 years (for women aged 50 years plus), to determine whether symptoms are still present. If symptoms return, HRT can be restarted. Patients should be made aware of the small increase risk of breast, endometrial cancers, DVT thrombo-embolism and stroke if on HRT for 5 to 10 years. It should be noted that being overweight, smoking and alcohol are associated with a greater risk of causing breast cancer than HRT.
See NICE guidelines or BNF for chart of HRT risk factors.
HRT is neither necessary nor appropriate for every woman, but for many women, HRT can provide significant benefits both for relief of distressing symptoms, improving quality of life and/or prevention / treatment of osteoporosis. The majority of women who take HRT do not have troublesome side effects but for those who do, adjustments can be made and many different treatment options are available. No arbitrary limits should be placed on the duration of usage of HRT. The type and duration of treatment should be individualised, taking into consideration symptoms, past history and family history, and balancing risks against benefits.
Route
If oestrogen is only required for vaginal or urinary symptoms, vaginal oestrogen is available in the form of a tablet, cream, or vaginal ring.
For more general symptoms such as flushes, sweats, joint aches or poor sleep, then a systemic route is advisable; e.g tablet daily, a weekly or twice weekly patch, or a daily gel.
Oestrogen combined with progestogen can be taken by tablet or weekly or twice weekly patch, and progestogen alone can be taken by tablet, vaginal gel
The different routes will have different benefits and risks from different. The main factors determining choice of route are individual preference, response and past medical history. Most often, HRT is started in tablet form.
See link to Menopause Matters website.
Non HRT treatment
Other treatment for women who do not want/can't to take HRT, includes herbal medicine, Cognitive Behaviour Treatment. See below link for further information.
Virtual Branch APTUK (Affiliate APTUK Kent Branch)
Kent Branch
Email: aptuk.kent@gmail.com
Location: Chatham Maritime. Kent
Phone: 01634 202940
Facebook: https://www.facebook.com/VirtualBranch1
Twitter: @AptukB