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Menopause & HRT

From Mediwikis

Menopause is defined retrospectively as a twelve month period following the final menstrual blood loss. The average age for menopause in the United Kingdom is around 51 years old. The state of perimenopause is defined as the time from which menses start to become irregular and FSH levels have increased, until the time when it is known that periods have ceased completely. However, this in reality can only be calculated in hindsight. This extended period of time around menopause is also known as climacteric.

Symptoms

Important symptoms of menopause include:

  • Hot flushes – caused by decreased oestrogen leading to an interruption in neurotransmitter activity at the hypothalamus, in turn resulting in rapid vasodilation.
  • Osteoporosis – caused by decreased oestrogen, leading to altered calcium metabolism and osteoporosis
  • Utrogenital changes – decreased elasticity and decreased epithelial thickness lead to an increased risk of trauma and bleeding.

Symptomatic Treatment:

Hot flushes

  • Clonidine (anti- HTN)
  • Serotonin agonists

Osteoprosis

  • Raloxifene (decreases bone loss)
  • Bisphosphonates (increases resorption resistance)
  • Calcitonin (decreases bone loss)

Urogenital Atrophy

  • Continue sexual activity
  • Pelvic floor physiotherapy
  • Various creams/gels

Hormone Replacement Therapy (HRT)

HRT can take the form of oestrogen alone or oestrogen + progesterone. Dual therapy is indicated when the patient has an intact uterus. HRT can be administered via tablets, transdermal implants/injections, sprays, creams or pessaries.

Side effects of HRT include:

  • Bloating
  • Oedema
  • Mastalgia
  • Skin changes
  • Headaches

Risks associated with HRT include:

  • Thrombosis
  • Vasodilation
  • CVS disease
  • HTN
  • DVT/PE
  • Breast cancer
  • Endometrial cancer