Menapause

Question 1

how would you diagnose ovarian failure using hormone levels?

Answer 1

Serum FSH level > 30 IU/l on 2 separate occasions = ovarian failure (menopause)

Question 2

which types of oestrgen predominate before and after the menapause?

Answer 2

Oestradiol (E2) is predominant in premenopausal women: produced by the ovaries

Oestrone (E1) is predominant in postmenopausal women : produced by peripheral conversion of androgens in the adipose tissue

E1 is less biologically active than E2

Question 3

what are the acute symptoms of the menapause?

Answer 3

—Vasomotor-

—Hot flushes

—Nights sweats

—General-

—Headache

—Fatigue

—Insomnia

—Arthralgia

—Psychological-

—Poor memory

—Loss concentration

—Irritability

—Low mood

—Anxiety

—

—Reduced libido

—Dizziness

Question 4

what are the medium term effects of menapause?

Answer 4

—Vaginal

—Dryness/itch/burning

—Dyspareunia

—Sexual dysfunction

—Prolapse

—

General

—Dry skin

—Hair thinning

—Urinary tract

—Urinary frequency/nocturia

—Urgency

—Stress/urge incontinence

—Recurrent UTI

Question 5

what are the long term consequences of the menapause?

Answer 5

—CARDIOVASCULAR DISEASE

CEREBROVASCULAR DISEASE

—(oestrogen increases HDL and reduces LDL)

—OSTEOPOROSIS

Question 6

to whom would you offer oestrogen only HRT?

Answer 6

ladies with total hysterectomy

Question 7

when is sequential HRT offered?

What does it consist of?

how long should be used for?

Answer 7

to peri-menapausal woman. When their symptoms start- even if they are still having their period

continuous oestrogen and 10-14 days of progesterone

use for a max of 5 years

Question 8

what treatment should be offered if the paitent is 54?

or

Their LMP was >1 year ago

Answer 8

Over 54 or LMP>1yr – start CC HRT

Under 54 – Sq HRT for 2yrs then switch CC HRT

Question 9

what is tribolone?

what group is it used in?

what are the risks?

Answer 9

—Synthetic steroid → weak oestrogenic, progestogenic and androgenic properties

postmonapausal woman, as an alternative to CC HRT

Similar to HRT until age of 60 then increased risk of strokes after

less risk of breast cancer than combined

Question 10

what are the benefits of a testosterone patch/ implant?

Answer 10

raised sense of well-being

raised libido

Question 11

what can be offered for local vaginal, bladder problems?

Answer 11

local oestrogen preperations- rings, tablets, gels

no systemic effect

Question 12

risk for what conditions goes down with HRT?

Answer 12

Colorectal cancer and osteoporosis

Question 13

relative risk for which conditions goes up with HRT

Answer 13

Breast cancer

Endometrial cancer

Ovarian cancer a little

VTE

Stroke

Question 14

what non-oetrogen based therapies are tried?

Answer 14

—Clonidine – no firm evidence in clinical trials but some women get benefit for ‘hot flushes’

—

—SSRIs (selective serotonin reuptake inhibitors) e.g. fluoxetine – as above

—

—SNRIs (serotonin and noradrenalie reuptake inhibitor) e.g. venlafaxine – as above

—

—Gabapentin - occasionally tried

Question 15

what dietry changes can be made?

Answer 15

Isoflavones

soy

legumes

lignans

berries

cereals