Menopause

Question 1

Menopause - Def

Answer 1

Cessation of menstruation - loss of ovarian function diagnosed clinically 12 months of amenorrhoea (but earlier than 50 risk pregnancy)

Question 2

Average age for menopause in UK

Answer 2

52 yo

Question 3

Def of perimenopause

Answer 3

= period before the menopause when endocrinological, biological and clinical features of menopause- decreasing oestrogen

Question 4

Def of premature menopause

Answer 4

2 SD below mean age ➤ <45 years in UK

Question 5

Menopause - causes

Answer 5

o Finite oocytes: ovarian follicular activity fails, oestrogen and inhibin decrease  reduced negative feedback causes FSH and LH to rise
o Low oestrogen levels: disrupt menstrual cycle, hot flushes- anovulatory

Question 6

Premature menopauses - causes

Answer 6

family history 
no cause found
surgery
chemotherapy
radiation
infection (TB, mumps, malaria, varicella, shigella)

Question 7

Menopause/Perimenopause - S&S

Answer 7

• Change in menstrual pattern
• Menorrhagia
• Hot flushes
• Night sweats
• Sleep disturbance
• Urinary and vaginal symptoms

Question 8

Menopause - Ix

Answer 8

o Not normally needed but may be required for premature menopause
o Blood tests (FSH and LH)  if on OCP difficult to evaluate

Question 9

Menopause - Management

Answer 9

o	Advice, lifestyle changes
o	Risks and benefits HRT
o	Topical oestrogen for vagina
o	Regular exercise
o	Lose weight
o	Reduce spicy foods, caffeine, triggers
o	POF - risk of osteoporosis

Question 10

HRT - Pros & Cons

Answer 10

o Menopausal symptoms: Flushes, depression, MSk complaints, sleep disturbance, QoL, vulvo-vaginal (RCT with placebo, meta-analysis)
o Osteoporosis: prevention and Rx (observational and RCT)- oestrogen dose dependent effect more beneficial younger<60y
o CHD- RCT: young healthy women <60y within 10y of menopause do NOT have increased CHD- prevents- affect oestrogen
o CHD: older >60y esp those established risk HRT cause add events- role of MMP and plaque instability- older women (>20y from menopause) used with caution- non-oral
o Stroke: overall risk of ischaemic stroke range 1.2 to 1.4- inconsistent findings <60y Cochrane analysis did not find increased risk- though known risk OCP though small
o Thrombosis risk: As with OCP increase risk 2-fold- dose related, increases with age- occurs early in Rx (usually)
o Cancer: decrease in colon cancer, breast most studies increased risk combined HRT- dose and duration related- risk small (> risk obs studies than RCT) oral CEE no increased risk up to 15y, oestradiol small risk. Combined HRT- increased risk esp MPA- risk over 5y still < obesity, dense breasts, late first child, occupational exposure
o Cancer: Endometrial cancer- unopposed oestrogen, Ovarian- remains controversial- due to the low prevalence of ovarian cancer difficult determine- overall 50-59y overall prevalence cancer low for oestrogen alone total cancer risk decreased by 20%
o Overall mortality: use of oestrogen obs studies 20-40% reduction (usually <60y)
o QoL: increase in QoL adjusted years (<60y)

Question 11

HRT alternatives

Answer 11

o	St John’s Wort (Hypericum perforatum) mostly depressive symptoms (Liu et al 2014) 
o	Exercise 
o	Vaginal lubricants and moisturisers 
o	Reducing caffeine/alcohol 
o	Acupressure
o	Acupuncture 
o	Homeopathy 
o	Aromatherapy
o	Black cohosh (hot flushes, night sweats)  has links to liver failure 
o	Selenium
o	Herbs
o	Phyto oestrogens, best evidence soy isoflavone (amenorrhoeic as lead to endometrial hyperplasia) 
o	Reflexology