17: Menopause

Question 1

What is the climacteric? What is menopause?

Answer 1

Climacteric = final menstruation (median age 53 years)

Menopause = absence of menstruation for 12 months

Question 2

Symptoms of perimenopause

Answer 2

• Vasomotor: hot flushes, night sweats
• Urogenital: vaginal dryness, itching, dysparenuria, recurrent UTI
• Psychological: mood wings

Question 3

Treatments for menopause

Answer 3

• Non hormonal: vitamin E, SSRI, clonidine, gabapentin

- Hormonal

Question 4

Risk of breast cancer appears at ___ years after HRT

Answer 4

1-2

Question 5

Additional harmful effects aged 50-79 years combined HRT vs oestrogen alone

Answer 5

breast ca +8 / no change
stroke +8 / +12
VTE +18 / +7
Alzheimers +23/no change
Colorectal ca -6/no change
Hip #/ -5/ -6

Question 6

Additional harmful effects aged 50-59 years combined HRT vs oestrogen alone

Answer 6

breast ca +5 / no change
stroke +2 / +3
VTE +11 / +4

Question 7

History of peri/post-menopausal woman

Answer 7

• LMP, cycle length, regular/irregular, duration, IMB, PCB
• Vasomotor symptoms: duration, severity, triggers, trx tried
• Urogenital symptoms: dryness, recurrent UTI
• Psychological symptoms
• Fractures
• PMHx: smears, mammograms, CVD, surgeries
• SHx: smoking, drugs, alcohol

Question 8

What are the different methods of administering HRT?

Answer 8

Oestrogen: oral, vaginal, transdermal, implant

Progesterone: oral, IUD

Question 9

Who should get:

• Oestrogen alone HT
• Continuous oestrogen and sequential progestogen HT
• Continuous oestrogen and progestogen

Answer 9

• oestrogen alone: hysterectomy
• continuous O and sequential P: perimenopausal (LMP within 12 months) 2 weeks of progestogen each month
• continuous O&P: >1 year menopausal

Question 10

Contraindications to oestrogen therapy

Answer 10

• Malignant: undiagnosed VB, previous Breast ca
• Haem: prev VTe
• CVS: previous heart attack, stroke, high risk CVD