Menopause scenarios. Anita 44yrs, 1 daughter age 6, trying to conceive for 2 years. Periods now irregular, every 6-10/52 Says she’s is under ‘pressure’

Slides:



Advertisements
Similar presentations
Managing Heavy Menstrual Bleeding
Advertisements

Contraception in the over 40’s
((Hormone replacement therapy))
for Bio-Identical Hormones
Hormone Replacement Therapy. 6/11/2014 OB-GYN Specialists, PC and Covenant Medical Center Hormonal Therapy Beliefs before July 2002 Relieves hot flashes,
HORMONE REPLACEMENT, AN OVERVIEW DR SARAH WHITFIELD.
Dysmenorrhea, Menopause, Fibrocystic Breast Disease Ricci, pp ; 101, 150;
Menopause and HRT. AIMS Menopause : How to diagnosis Symptoms Treatments Premature menopause HRT : indications/contraindications.
Tailoring HRT to the patient Dr Bruce Davies To insert your company logo on this slide From the Insert Menu Select “Picture” Locate your logo file Click.
Periodic Woman Screening Sheet By Periodic Woman Screening Committee January 2010.
Young People Postnatal women Peri-menopausal women.
Hormone Replacement Therapy Dr Belinda Magnus. Menopause - Background  Vasomotor symptoms affect around 80% women during the menopause – severe in 20%
Women’s Health 1 Dr Pamela Sides Tuesday 22nd March 2011 Dr Pamela Sides Tuesday 22nd March 2011.
Dr. Zhao TCM Help Menopause! Menopause is the permanent end of menstruation. It can have a big impact on a woman's wellbeing such as physical upheaval.
The Family Planning Clinic. For each of the cases Consider the factors raised by the case Advise about options, including alternatives.
Sharan Pobbathi Alena Billingsley
HRT In a nutshell for all the blokes out there. diagnosis  Clinical hx  FSH limited value as levels fluctuate  May be of value in symtomatic women.
IS HRT SAFE? Rosol Hamid Consultant O&G. NO What is safe? Driving Swimming Crossing the street Cycling Riding a motor bike Parachute jumping Flying.
Few more cases Cancer and cholesterol. Cancer and genetic testing Available guidance (NICE) Familial breast cancer /colonic/ovarian Familial Hypercholesteremia.
Menopause and HRT.
Chapter 61 Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications 1.
To treat or not to treat? Highly individualized. Debilitating symptoms. Mild symptoms.
MENOPAUSE MENOPAUSE. WHAT ? Menopause is a deviation of the ancient Greek words menos ( month) and pauses (ending). menopause is sometimes known as the.
Hormone Replacement Therapy
Contraception Cases From Practice Dr P Feldman Contraception Major social change Major social change Reproductive self determination Reproductive self.
Contraception Matthew Dowling 10/9/14.
April Back to Basics, 2011 POPULATION HEALTH: Periodic Health Exam, Epidemiology & Community Medicine Based on slides prepared by Dr. R. Spasoff.
Management of men and women over 50yrs who have sustained a fragility fracture: 2011 draft guidance Fragility fracture definition: Fracture site excluding.
M E N O P A U S E King Khalid University Hospital Department of Obstetrics & Gynecology Course 481.
The Menopause and HRT.
MANAGING THE MENOPAUSE SUMMARY HRT appropriate for moderate to severe symptoms HRT appropriate for moderate to severe symptoms HRT should not be.
MENOPAUSE DR. AMEL EL-SAYED, FRCSC Assistant Professor & Consultant King Saud University King Khalid University Hospital.
How to survive your menopause David Griffiths Consultant Gynaecologist Christine Pearce Consultant Nurse 3 rd Sept 2014.
Antenatal and fertility
Family medicine Common problems in Obstetric and Gynaecology.
Dr Sylvia Bond 16/9/09.  1 point type and 1 point brand name  Cyclical( sequential)  CCT ( Continuous Combined Therapy)  Unopposed.
MENAPOUSE. Natural Surgical premature RETROSPECTIVE Cessation of menstruation for 12 months In the absence of other physiological or psychological.
Menopausal Hormone Replacement Professor Gordana Prelevic, MD, DSc, FRCP Consultant Endocrinologist Royal Free Hampstead NHS Trust Whittington Health.
Abnormal Uterine Bleeding
Menopause Case Study. VETERANS HEALTH ADMINISTRATION Case Study Marion, a 52-year-old female veteran, presents to your office for evaluation of hot flashes.
Contraception Case Study Interprofessional version
What does it mean to age? Deterioration over time! This can include; weakness, susceptibility to disease, loss of mobility and agility. The reduced ability.
Adult Medical-Surgical Nursing Reproductive Health Module: Endometrial Cancer.
Menopause Case Studies Interprofessional version
Women’s Health Update Beverley Hall June Aims and Objectives Why Women’s Health? Emergency Contraception Menopause Practical HRT assessment.
The 21 st - Century Well Woman Exam Honor MacNaughton, MD, Linda Prine, MD, Ruth Lesnewski, MD Beth Israel Institute for Urban Family Health, New York.
Contraception in the over 40s Ruth Adams Clinical Educator Leicester Sexual Health.
If patient suffers from acne, consider desogestrel-containing COCs Co-cyprindiol (Dianette ® ) is licensed for the treatment of severe acne and hirsutism,
Hormone Replacement Therapy – An Insight!
HORMONE REPLACEMENT THERAPY (HRT) Evidence-based Guidelines Dr Mahdy El- Mazzahy Damietta general Hospital 7 th International Annual Congress “Alexandria”
M E N O P A U S E King Khalid University Hospital Department of Obstetrics & Gynecology Course 482.
POST-MENOPAUSAL SYMPTOMS AND TREATMENT James Simpson Tuesday, April 26 th 2016.
Living with the Menopause Dr Henrietta Antscherl
Dr Lisa Pickles. GP Brig Royd, Ripponden. November 2016.
‘Dr….I get really bad hot sweats and always feel irritable’
Hormone Replacement Therapy
Contraception in the over 40’s
MENOPAUSE.
Menopause
DR FULVA DAVE 29th November 2016
Dr Lisa Pickles. GP Brig Royd, Ripponden. December 2017
Contraception in the over 40’s
Chapter 61 Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications 1.
Women’s Health Dr Emma Broughton GPwSI
Menopause Update Dr Fiona Jacklin April 2018
MENOPAUSE & HRT Nicola Stewart 28/02/2018.
GP Education Meeting September 2018
Hormone Replacement Therapy (HRT)
Tailoring HRT to the patient
Menopause and HRT- made easy Anita Juliana MBBS, MD, FRCOG Consultant Obstetrician and Gynaecologist Menopause Lead for NUH.
Presentation transcript:

Menopause scenarios

Anita 44yrs, 1 daughter age 6, trying to conceive for 2 years. Periods now irregular, every 6-10/52 Says she’s is under ‘pressure’ from her husband who wants a son

Does she want another child? Symptoms of menopause, flushes, libido? Mood? How is her relationship with her husband, think about abuse. What does she know about the menopause? FH, menopause/VTE/breast cancer PMH, breast disease, VTE, liver disease What questions are you going to ask her?

What investigations will you do? FSH Consider FBC, TFT, HbA1c, Vit D, Lipids, LFT Check smear, consider swabs bp, BMI, Smoking Breast exam

If she is perimenopausal what treatment would you offer? Sequential combined HRT, will have regular bleeds Can be monthly or 3 monthly Oral first line as cheap eg Prempak C Patch avoids first pass effect and does not effect clotting/VTE risk eg Evoral sequi If she needs contraception Mirena plus oestrogen tablet, gel or patch is an option

What advice will you give about contraception? Needed for 2 yrs after last period if <50y 1 yr after period if >50y POP licensed can use coc up to 50y if fit non smoker, consider low dose has section on contraception over 40

Belinda, 49yrs single 2 teenage kids. Works as HCA, 12hr shifts, money tight and worries re kids. Sleep poor. Recently started a relationship with a man, no sex yet, she is anxious about it. Lmp 13/12 ago.

What do you need to explore further? What does she know about menopause? Mood? Sleep disturbance, night sweats? Libido, what are worries re new relationship?Think about atrophic vaginitis FH re menopause/breast cancer PMH re breast disease, VTE, liver disease

What investigations will you do? NOT FSH Consider FBC, TFT, HbA1c, vit D, lipids, LFT Check smear, bp, BMI, smoking, advice re breast exam Advice re STI screening

What advice will you give her? Contraception… Continuous combined HRT, no period 2yrs 50y Again oral or transdermal available, no bleed Refer if still bleeding after 6/12 treatment or after period of amenorrhea Can consider tibolone, better for libido, more likely to bleed. Vaginal oestrogen, eg Vagifem no inc risk VTE or cancer can use long term

Cathy 58 yrs, head teacher lives with husband Struggling at work due to hot flushes, poor sleep, worries she is being ratty with her husband who recently retired. Fell on ice in Jan and had Colles left wrist. Hysterectomy 3 yrs ago. Declined HRT last year as worried about SE.

What do you need to explore? What are her worries about HRT? Libido? Mood? Self medication eg herbal remedies, alcohol Has fragility fracture been followed up? See NICE osteoporosis guidelines

What advice will you give her? Oestrogen only HRT Remember transdermal has NO increased VTE risk Will reduce fracture risk while she is taking it. HRT started < 60yr no increased IHD risk, ? benefit Breast cancer risk negligible with oestrogen only HRT

Alternatives to HRT SSRI for flushes, topical testosterone for libido, both off license St Johns Wort Vaginal lubricant Replens, Yes, Sylk CBT, antidepressants Vaginal oestrogen, eg Vagifem no inc risk VTE or cancer can use long term

Key Messages about risk Oestrogen increases VTE risk but not if transdermal. Also increases risk of endometrial cancer if not given with progesterone. Progesterone increases risk of breast cancer but only slightly with long term use. Combined HRT may protect against IHD if started under 60yr, increases risk slightly over 60yr.

Combined HRT, 3/1,000 extra cases in women with 5 yrs use. Risk comparison, alcohol, obesity, HRT > 2-3 units alcohol/day 1.5x Postmenopausal obesity 1.6x > 5yrs HRT 1.35x Breast cancer risk

The future Bio identical progesterones may not have increased breast cancer risk Are anxiolytic/hypnotic steroids E.g. Utrogestan licensed for use with oestrogen as combined preparation

Useful resources has section on contraception over ire_hrt_guidance_2014.pdf very useful summary ire_hrt_guidance_2014.pdf patient info leaflets latest menopause guidelines