Menopause Update Dr Fiona Jacklin - PowerPoint Presentation

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Menopause Update

Dr Fiona Jacklin

April

2018

MENOPAUSE

Final period 45-55 (average 51)

Starts in mid to late 40’s

Early menopause

Surgical menopause

Menopause due to cancer treatment

MENOPAUSE

80 % experience symptoms

25% have severe symptoms

50% experience hot flushes for up to 7 years

Tests not usually required

SYMPTOMS

Change in periods

Hot Flushes

Night sweats and sleep disturbance

Low mood and anxiety

Memory and concentrations problems

Generalised

aches and pains

Skin irritation

Low sex drive

SYMPTOMS

Vaginal dryness , itching or burning

Vaginal discharge

Painful intercourse

Urinary urgency and frequency

Recurrent urinary tract infections

ASSOCIATED DISEASES

Cardiovascular disease - increases after the menopause

Osteoporosis - decline in bone density

Redistribution of body fat – risk factor for Diabetes

Alzheimer's disease – high incidence than men

WHAT CAN I DO TO MINIMIZE THE EFFECTS OF THE MENOPAUSE ?

Healthy diet – protect bones and heart

Regular weight bearing exercise

Maintain a healthy weight

Stop smoking

Keep to alcohol recommendations

Breast self examination

Take part in NHS screening

Recognize increased stress and anxiety

TREATMENT OPTIONS - HRT

Most effective treatment

Helps hot flushes , night sweats mood swings, vaginal and bladder symptoms

Reduces risk of osteoporosis

Reduces risk of coronary heart disease if started within 10 years of the menopause

Benefit to collagen, muscle mass and strength

Possible reduction in colorectal cancer and dementia

RISKS OF HRT

Blood clots - risk lower with patches or gels

Stroke – only with oral preparations

Breast Cancer –with combined preparations

Heart Disease –if started over 60

Endometrial Cancer – progesterone protect

Ovarian Cancer – not confirmed

BREAST CANCER RISK

4 extra cases per 1000 women over 5 years

Same risk as drinking 2-3 units of alcohol daily

No increased risk under age 51

No increased risk of dying from breast cancer

Combined HRT increases breast density and risk of abnormal mammogram

SAFETY CONCERNS

1940’s –first prescribed

1960’s –widely used

1990’s- 2 large studies suggested extended use may increase risk breast cancer and HRT use may cause heart disease

New guidance issued, number of women using HRT fell by 66 %

2000’s – further evidence to suggest protective for heart disease if taken within 10 years of menopause

SHOULD I TAKE HRT ?

For most women it is safe and effective

Need a clear indication for HRT

No contraindications

Taken at the lowest effect dose for shortest time

Starting HRT within 10 years of the menopause

Needs to discuss with own GP and assess individual benefits and risks

Have an annual medical review

Remember you still need contraception

WHICH HRT ?

If you have had a hysterectomy –

oestrogen

only

If womb intact –

oestrogen

and progesterone

Periods stopped less than a year ago –

sequential combined HRT

Periods stopped over a year ago

– continuous combined

Delivery system – oral , patch , gel, nasal spray , vaginal ring , Intrauterine device

VAGINAL HRT

Good evidence helps vaginal and urinary symptoms

Contraindicated with active breast cancer /undiagnosed vaginal bleeding

A year’s supply of vaginal

oestrogen

is equivalent to having one tablet of standard HRT

Vaginal lubricants

ALTERNATIVE TREATMENTS

Herbal - Black cohosh , Evening primrose oil , Ginseng , St John’s Wort

Phyto-

oestrogens

– Soya , Red Clover

Many not proven to be safe or effective

Can have interactions with other medications

Look for -THR ( Traditional Herbal Registration) on packet

ALTERNATIVE TREATMENTS

CBT

Mindfulness

Antidepressant medication

eg

citalopram – can help flushes

Gabapentin

Summary

Menopause symptoms are individual

Important

to optimize

lifestyle

HRT can be a safe and effective treatment

Can consider alternatives remedies

Menopause Update

Dr Fiona Jacklin

April

2018