Disorders of the menopause

Question 1

What is the menopause?

Answer 1

cessation of menstruation that is diagnosed after 12 months of no periods

Question 2

What is the average age for the menopause ?

Answer 2

51

Question 3

What is the perimenopause?

Answer 3

period leading up to the menopause with irregular periods and symptoms

Question 4

What causes the symptoms of the menopause

Answer 4

Low oestrogen

Question 5

What are the short-term symptoms of the menopause?

Answer 5

Vasomotor symptoms: hot flushes and sweats – impact on sleep 
MSk: joint and muscle pain 
Low mood and sex difficulties  
Poor memory and concentration 
Low energy and confidence 
Headaches 
Itchy skin 
Atrophy of breast  and skin

Question 6

What are the medium-term symptoms of the menopause?

Answer 6

Vaginal dryness can cause dyspareunia, UTIs, prolapse and PMB

Question 7

What are the long-term effects of the menopause?

Answer 7

Osteoporosis
CVD –lipid changed adversely
dementia

Question 8

What is the conservative management for the menopause?

Answer 8

Diet and exercise

CBT

Question 9

What are the medical interventions for the menopause?

Answer 9

Oestrogen cream for vaginal dryness
SSRIs for vasomotor symptoms eg fluoxetine, citalopram, sertraline etc.
Anti-epileptics eg gabapentin
Alpha adrenergic receptor agonist- clonidine- hot flushes
OP- give calcium, vit D and bisphosphinates
HRT
Still need contraception until a year with no period post 50 and two years under 50 yrs.

Question 10

What are the surgical interventions for the menopause?

Answer 10

Mirena coil

hysterectomy

Question 11

Which symptoms indicate the need for HRT?

Answer 11

vasomotor and mood symptoms

Question 12

How often should progesterone be used with HRT and why?

Answer 12

Progesterone should be used every 12-14 days every 4 weeks- sequential. To protect from endometrial cancer
Use cyclical if perimenopausal to give them a period, continuous if post menopausal as no need for bleed

Question 13

What are contraindications for HRT?

Answer 13

PV bleed, breast lump, acute liver disease, fibroids, uncontrolled BP, migraine, epilepsy, VTE fhx
CAUTION if over 60 yrs

Question 14

What are the advantages of HRT?

Answer 14

relief of symptoms and BMD protection

Question 15

What are the risks of HRT?

Answer 15

Breast cancer- no effect with oestrogen alone, bigger effect with progesterone added
VTE – risk only in PO not transdermal
CVD- not a CI as long as other CVS risks are managed. Doesn’t have an effect if started before age 60
Irregular bleeding

Question 16

What is premature ovarian insufficiency?

Answer 16

Menopause less than 40 yrs

Question 17

What causes premature ovarian insufficiency ?

Answer 17

Mainly idiopathic, can be chromosome abnormalities, autoimmune disease etc, can be iatrogenic eg chemo or surgery