Menopause

Data gathering

  • Red flags
    • Abdominal pain/swelling
    • PMB, PCB
    • Weight loss
  • Others
    • Hot flushes, Mood changes, Vaginal dryness, Libido
    • Smears, Breast
    • PMH/FH – Heart problems, Liver problems, Ca (breast/ovarian/endometrial), Clots, Migraines
  • Examine
    • BP, BMI
    • Breast

Clinical management

  • Investigations
    • Bloods – FSH/LH/oestradiol
  • Explanation
      • Menopause happens when the ovaries stop producing eggs, results in lower female hormone of oestrogen which can cause symptoms such as mood changes, hot flushes, dryness of vagina
  • Treatment
    • Lifestyle
      • Diet, Exercise, Loose clothing, Reduce alcohol/caffeine
    • Psychological
      • CBT
    • Non Hormonal
      • SSRIs
      • Vaginal lubricants
    • HRT
      • Oestrogen/progesterone combined
      • Different preparations – tablets, patches, gels
      • Benefits – reduces hot flushes, protects against osteoporosis
      • Disadvantages – small inc risk of breast cancer, clots, endometrial cancer
      • Cyclical vs Continuous
        • Cyclical preparations used for those still have erratic menstrual bleeding, oestrogen is taken daily, progesterone is taken for last 14 days of cycle, monthly periods continue
        • Continuous preparations are used once woman has not had period for 1 year – daily oestrogen and progesterone
  • Follow-up / Safety net
    • HRT – follow up after 3 months of starting then 6 monthly thereafter – reviews should include BP, weight, breast examination
    • PMB – see doctor

Notes

  • Complementary therapies – black cohosh but poor regulation on dose, purity – look for THR (Traditional herbal registration) logo which is a regulatory body to help standardise these things
  • Bones – diet rich in calcium and vitamin D e.g. pint of milk, hard cheese, yoghurt or OTC
  • Usually around 5 years HRT
  • Importance of up to date with breast screening
  • https://www.gwh.nhs.uk/media/163808/wiltshire_hrt_guidance_2014.pdf