Intro to menopause

Question 1

Average age of menopause in UK?

Answer 1

Around 51 years old

Question 2

Menopause in ages 40-44 year old is regarded as what?

Answer 2

Early menopause (around 5% of female population)

Question 3

What is premature ovarian insufficiency?

Answer 3

Experiencing menopause in younger than 40 years old. Occurs in around 1% of female population.

Question 4

What is perimenopause?

Answer 4

Means “around menopause” and refers to the time during which your body makes the natural transition to menopause, marking the end of the reproductive years.

Question 5

perimenopause is usually associated with regular periods. true/false?

Answer 5

False

Premenopause usually associated with regular periods.

Perimenopause usually associated with less or more frequent (overall irregular) periods.

Question 6

How long do menopause symptoms usually last?

Answer 6

Around 7 years

Question 7

3 most common symptoms of menopause?

Answer 7

Mood swings
Hot flushes
Night sweats

Question 8

Other associated symptoms of menopause?

Answer 8

Memory loss
Anxiety
Brain fog
Dizziness
Dry skin + hair
Painful sex
Weight gain

Question 9

Diagnosis of peri-menopause?

Answer 9

Many women develop menopausal symptoms years before their last period = perimenopause

Menopause symptoms charts can help to diagnose (peri-)menopause and to help monitor treatment.

Question 10

For peri-menopause diagnosis in what cases and how often are FSH levels taken?

Answer 10

x2 (6 weeks apart)

In women > 45 with atypical symptoms (suspected premature menopause).

In women 40-45 with menopausal symptoms and/or iatrogenic amenorrhoea caused by factors such as hysterectomy, endometrial ablation etc.

Question 11

What is menopause caused by?

Answer 11

Lack of ovarian follicular function

Question 12

Sex hormone levels in menopause?

Answer 12

Oestrogen and progesterone levels are low

LH and FSH levels are high, in response to an absence of negative feedback from oestrogen

Question 13

Process of oestrogen secretion during menstrual cycle?

Answer 13

Inside the ovaries, the process of primordial follicles maturing into primary and secondary follicles is always occurring, independent of the menstrual cycle.

At the start of the menstrual cycle, FSH stimulates further development of the secondary follicles.

As the follicles grow, the granulosa cells that surround them secrete increasing amounts of oestrogen.

Question 14

How oestrogen affected during menopause?

Answer 14

process of the menopause begins with a decline in the development of the ovarian follicles.

Without the growth of follicles, there is reduced production of oestrogen.

Question 15

As a result of low oestrogen secretion during menopause, FSH and LH levels are higher due to lack of negative feedback from oestrogen. true/false?

Answer 15

True

Oestrogen has a negative feedback effect on the pituitary gland, suppressing the quantity of LH and FSH produced.

Lack of oestrogen = more LH and FSH produced

Question 16

How does lack of follicular development cause lack of menstruation?

Answer 16

The failing follicular development means ovulation does not occur (anovulation), resulting in irregular menstrual cycles.

Without oestrogen, the endometrium does not develop, leading to a lack of menstruation (amenorrhoea).

Question 17

Lower levels of oestrogen also cause the perimenopausal symptoms. true/false?

Answer 17

True

Question 18

Lack of oestrogen in perimenopausal period leads to what symptoms?

Answer 18

Hot flushes
Emotional lability or low mood
Premenstrual syndrome
Irregular periods
Joint pains
Heavier or lighter periods
Vaginal dryness and atrophy
Reduced libido

Question 19

What conditions can lack of oestrogen lead to?

Answer 19

Cardiovascular disease and stroke
Osteoporosis
Pelvic organ prolapse
Urinary incontinence

Question 20

Pregnancy after 40 years of age comes with risks and complications. true/false?

Answer 20

True

Question 21

UKMEC 1 (no restriction) contraception for women approaching menopause?

Answer 21

Barrier methods
Mirena or copper coil
Progesterone only pill
Progesterone implant
Progesterone depot injection (under 45 years)
Sterilisation

Question 22

Why is progesterone depot injection not used over aged 45?

Answer 22

weight gain and reduced bone mineral density (osteoporosis). These side effects are unique to the depot and do not occur with other forms of contraception.

Reduced bone mineral density makes the depot unsuitable for women over 45 years.

Question 23

Difference between menopause and perimenopause?

Answer 23

Perimenopause is when patient starts experiencing symptoms of menopause however periods have not stopped.

Question 24

Menopause is classed when there is cessation of menstruation for >2 years. True/false?

Answer 24

False

Menopause = cessation of menstruation > 12 months (1 year)

Question 25

Management of perimenopausal symptoms?

Answer 25

No treatment
Hormone replacement therapy (HRT)

Tibolone, a synthetic steroid hormone that acts as continuous combined HRT (only after 12 months of amenorrhoea)

Clonidine, which act as agonists of alpha-adrenergic and imidazoline receptors

Cognitive behavioural therapy (CBT)

SSRI antidepressants, such as fluoxetine or citalopram

Testosterone can be used to treat reduced libido (usually as a gel or cream)

Vaginal oestrogen cream or tablets, to help with vaginal dryness and atrophy (can be used alongside systemic HRT)

Vaginal moisturisers, such as Sylk, Replens and YES