Pwh Menopause

Front 1

What is menopause?

Back 1

The permanent cessation of menstruation
resulting from loss of ovarian follicular activity.
Recognized to have occurred after 12 consecutive
months of amenorrhea. No one bio marker

Front 2

Median age of menopause overall and white, industrialised women?

Back 2

Median age 45–55 years world-wide, 50–52 years
in white women from industrialized countries

Front 3

Who has earlier onset?

Back 3

Earlier onset associated with smoking,
malnutrition, ill health

Front 4

What is premature menopause?

Back 4

before 40

Front 5

How common is premature menopause?

Back 5

1% before 40,
0.1% before 30
0.01% before 20

Front 6

What causes early menopause?

Back 6

idopathic
familial in 20-30%
chromosome abnormalities
autosomal translocations
autoimmune -20% hypothyroid, 3% addisons, 2-3% DM
Infectious-mumps, varicella etc (2-8% of those affected)
Iatrogenic - ovarian surgery, childhood chemo/rad (4-8% of them will have premature gonadal dysfunction)

Front 7

What are the longterm consequences of early menopause?

Back 7

. Vasomotor symptoms
90% of women with surgical menopause
80% of women with breast cancer
. Psychological effects
. Sexual dysfunction
. Infertility
. Early bone loss
. Cardiovascular disease
. Causally related diseases
. Early death

Front 8

Do people ever regain fertility after early menopause?

Back 8

› Recovery of ovulation may occur in up to 50% of women with spontaneous early menopause although it is impossible to predict in whom or for how long.

› Spontaneous pregnancy may occur in 2-10% of women with premature gonadal dysfunction.

› Recovery of ovarian function after a chemo or radiotherapy induced menopause decreases with increasing patient age, the dose of radiation and the type of chemotherapy used.

Front 9

How significant is early menopause in terms of bone loss?

Back 9

Menopause before age 40 will reduce BMD by a T score of 1 greater than normal menopause by age 65

Menopausal age correlates strongly inversely with increased fracture risk

Front 10

What are the CVD effects of menopause?

Back 10

› Total Cholesterol rises within 3 years
› LDL Cholesterol rises within 3 years
› HDL does not appear to change as much
› BP and insulin resistance do not change initially„

Risk increases with early menopause
„Early surgical menopause increases risk further

Front 11

What diseases are associated with idiopathic premature ovarian failure?

Back 11

› Thyroid disease (15-20%)
› Addisons disease (2-3%), (50% with adrenal Antibodies )
› Diabetes (2-3%)
› Polyglandular syndromes (3%)
› Dry eye / ocular surface disease (up to 20%)
› SLE, Rheumatoid arthritis
› Galactosemia, myasthenia gravis

Front 12

What are the symptoms of menopause?

Back 12

› Central: Hot Flushes, Night sweats, Insomnia,
Mood & memory changes
› Joints and Muscles: aches and pains , osteoarthritis
› Skin: Dryness, thinning, loss of elasticity, formication, acne
› Teeth: Reduced saliva, increased gingivitis, changing taste
› Vulva and Vagina: Dryness, thinning labia, dyspareunia, vulval eczma and skin conditions
› Bladder: Increased urinary urgency, frequency,
incontinence and urinary tract infections
› Hair: Increased facial hair, thinning scalp and pubic hair
› Long Term: Cardiovascular and Skeletals

Front 13

How common are hot flushes?

Back 13

› Hot flushes occur in 65% of women in Western countries
› Marked variation in prevalence globally

Front 14

How common are severe hot flushes?

Back 14

25%

Front 15

How long do hot flushes last?

Back 15

› Over 80% of women who experience hot flushes will
experience them for more than 1 year
› 9% of women experience hot flushes beyond the age of 70years

Front 16

What is the treatment of hot flushes?

Back 16

› Life style changes
› Hormone-based therapies
› SSRIs
› Gabapentin
› Alternative medicine approaches

Front 17

Do phytoestrogens work for menopause?

Back 17

little convincing evidence

Front 18

What prescription treatments can be used for vasomotor symptoms?

Back 18

Clonidine:
› Alpha adrenoreceptor agonist, Reduces vasoconstriction
› Clinical effect modest
› Side effects: constipation, dry mouth, drowsiness
› Long term data lacking
Gabapentin:
› Gamma amino butyric acid analogue used as anticonvulsant
› Probably acts as hypothalamic thermoregulator
› 4 RCTs show significant reduction in vasomotor symptoms at 900mg per day with a clear dose response relationship
>ssris

Front 19

Which SSRIs are good for menopausal sx?

Back 19

› Paroxetine, Venlafaxine, Desvenlafaxine, Citalopram and Escitalopram
all reduced flushes by about 67% in short term RCTs
(16% drop out due to side effects)
› Fluoxetine reduced hot flushes by 50% compared to placebo 36%
› Sertraline no better than placebo

Front 20

Which SSRIs should not be given if on tamoxifen?

Back 20

Paroxetine and sertraline may impair tamoxifen function

Front 21

How often should postmenopausal women have a check up?

Back 21

annually at least

Front 22

What is the most effective treatment for hot flushes?

Back 22

HRT

Front 23

What is the major reason people seek HRT?

Back 23

flushes

Front 24

If HRT is initiated close to menopause, what effect does it have on CHD and mortality?

Back 24

There is now consistency between RCT and observational data that HRT initiated close to the menopause significantly reduces CHD and overall mortality

Front 25

When should HRT be commenced?

Back 25

Cumulated data supports a window of opportunity for maximal reduction of CHD and overall mortality with HRT initiation before age 60 or within 10 years of the menopause and continued for 6 years or more

Front 26

What is the effect of HRT on stroke?
Is estrogen or combined worse?

Back 26

healthy post menopause
not modified by age or proximity to menopause
risk similiar for E and E and P
1 additional stroke per 1000 women using it for 5 yrs
limited evidence transdermal estradiol may not increase risk

Front 27

All oral HRT increases the risk of VTE, which is worse?

Back 27

E and P is worse than E alone

Front 28

What else increases risk of VTE in HRT?

Back 28

age, obesity, thrombophilias

Front 29

Does transdermal HRT increase risk of VTE?

Back 29

no

Front 30

Does HRT make a difference to people at low risk of osteoporotic fractures?

Back 30

yes

Front 31

Add image from slide 56

Back 31

x