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Themes

  • Menopause
  • The Ageing process
  • Degenerative disease

Concepts

  • Normal ageing
  • Neoplasia
  • CNS and its blood supply
  • Neurodegenerative disease
  • Social/ethical issues

Reponses to scenario

  • Hot flushes
    • Varies, may involve sweating, can be overpowering, make her turn red
    • Flush begins in head, sweat runs down her back
    • Feel really hot
    • Needs to watch the clothes she’s wearing
    • Stress can bring it on
      • School head-teacher, makes for awkward situations
    • EMBARRASSING
    • Night – insomnia
      • Air con
      • change of lifestyle
      • Feel awake all night
      • Sweating, chills
    • 10 minutes in length, break, then starts again
  • Dry vagina
  • Doesn’t want HRT, doesn’t think symptoms are bad enough – just wants so relief
  • Treatments
    • Currently have tried: aircon, not much else
    • Natural therapies that can work
      • Phyto soya
      • Remifemin
  • Tablet, gel moisturiser, body lotion
    • May still have sweats for 1-5 years
    • Stop using soap
  • Important tests:
    • Bone density – ankle chemist test may not be enough (DEXA)
    • A scan is recommended, not all bones are affected equally
  • Some other person
    • Tried to come off HRT because of scary media reports
    • Sweats, hot flashes etc came back
    • Spicy food, caffeine make it worse
    • Tried remifemin
    • Had bone density scan, slight reduction in spine, but improved with HRT
    • No other health problems other than flashes
    • Unusual: had a period then the next one didn't come

Doctor's speech

  • Menopause = last period = permanent ovarian failure
  • 51 is average age to stop menstruating (normal range = 40-60)
  • Most women go through perimenopause - 10 years before menstrual cycle will shorten, and as the last couple of years she'll skip a few periods. She'll get low oestrogen months and high oestrogen months
    • High E month (pituitary starts responding): get very heavy periods after it, with very sore breasts
  • Symptoms of hot flashes come due to oestrogen withdrawal symptoms (sweats, flashes and moodswings also happen in drug addiction)
  • 25% of women stop menstruating asymptomatic
  • 25% have nearly nothing
  • 25% moderate
  • 25% seek medical attention
  • 1 in 8 women will never stop having flashes
    • Which we can fix with HRT (risk of breast cancer - 8 per 10000 women per year: increased from 30/10000 to 38/10000)
  • Asian cultures - the commonest symptom is headache (not as many flashes reported). Indians get the least hot flashes.
  • Western world - ageing sucks. Asian cultures etc, a woman's period stops and she becomes the matriarch of the community.
    • This impacts on the symptoms
  • Menopause can shatter people because of a lack of sleep
  • Above the age of 60, some people are unable to have intercourse because of vaginal dryness. Many asian women are too shy to tell people about it (and then they'll let their husband have sex with other women because of this)
  • HRT is virtually 100% effective
    • But there is an epidemic of fear surrounding it because of this 10 year anniversary of the Women's Health Initiative
    • This study is a prevention study for diseases of ageing for women (but it was for women with no severe menopausal symptoms)
  • Oral HRT is prothrombotic because of its effect on the liver (which produces clotting factors)
  • Hormones don't cause breast cancer (they affect its progression, but don't cause it). Breast cancer stem cells don't have hormone receptors, but their offspring do
  • Fear, shame, intimidation from the
  • When trying to give risks to patients, use ABSOLUTE RISKS and give them SOMETHING TO COMPARE IT TO
  • Everyone's scared of HRT
    • It changes the composition of cancers to slightly higher proportion of breast cancers and lower proportion of bowel cancer and uterus cancer
    • But the overall risk of cancer is the same
  • Mechanism of action of remifemin isn't understood
  • SSRIs and gabapentins may also help menopause
  • Relative risk = percentage risk
  • Absolute risk = difference in risks