Menopause

Question 1

what is menopause ?

Answer 1

permanent cessation of menstruation that results from loss of ovarian follicular activity

Question 2

when is natural menopause recognized ?

Answer 2

after 12 months of amenorrhea with no pathological cause ( 45-55)

Question 3

what is premature menopause ?

Answer 3

menopause before the age of 40

Question 4

what is peri-menopause ?

Answer 4

also known as menopausal transition , which is the time before menopause

Question 5

what are the symptoms of peri menopause ?

Answer 5

hot flushes
night sweats
mood swings

Question 6

how do we make a diagnosis of menopause ?

Answer 6

amenorrhea for more than n12 months
elevated serum FSH
low E2 levels
Menopausal symptoms

Question 7

what are the types of regimens of HRT ( Hormonal replacement therapy) for menopause ?

Answer 7

oestrogen
sequential regimen
combined regimen

Question 8

what is the disadvantage with the oral route taken for HRT ?

Answer 8

the drug bioavailability decreases due to the first pass metabolism in the liver

Question 9

what is the alternative pathway to oral HRT ?

Answer 9

transdermal route by skin patches

Question 10

what are the risks of HRT ?

Answer 10

VTE
Breast Cancer
Endometrial Stimulation
Cardiovascular Events

Question 11

when do we start assessing for risk of fracture and osteoporosis ?

Answer 11

in all women above aged 65 years and over

Question 12

when do we start assessing women under the age of 65 for fractures and osteoporosis ?

Answer 12

previous fragility fracture
current use or recent use of glucocorticoids
history of falls
family history of hip fractures
low BMI
Smoking
alcohol intake of more than n14 units per week

Question 13

what are the different methods of risk assessment of fracture risk and osteoporosis ?

Answer 13

FRAX/DEXA scan
or
Q fracture

Question 14

what does the Q fracture show or indicate ?

Answer 14

estimates the 10 year predicted absolute fracture risk

Question 15

what are the primary osteoporosis prevention treatment options for postmenopausal women ?

Answer 15

1. oral bisphophonates ( alendronic acid) only if :
2. the person is eligible of risk assessment
3. the 10 year probability of osteoporotic fragility fracture is at least 1%
4. intravenous bisphosphonnates

Question 16

what is the mechanism of action of intravenous bisphophonates ?

Answer 16

inhibit osteoclastic bone resorption

Question 17

When is Denosumab used in the treatment of osteoporosis ?

Answer 17

in post menopausal women at increased risk of fractures :

• who are unable to comply to oral biphosphonate
• have an intolerance or contraindication to these treatments

Question 18

what other treatment can be given for post menopausal women who cannot comply to alendronic acid ?

Answer 18

Raloxifine

Question 19

what are the risks associates with combined estrogen-progesterone HRT ?

Answer 19

increased risk of :
Breast cancer 
venous thromboembolism 
stroke 
pulmonary embolism

Question 20

what is the sequential regimen of HRT?

Answer 20

oestrogen alone for 2 weeks followed by a combination of oestrogen and progesterone

Question 21

what id the combined regimen of HRT?

Answer 21

daily continuous combination of oestrogen and progestarens

Question 22

what are the advantages of using the combines regimen of HRT ?

Answer 22

less bloating , weight gain and less mastalgia ( breast pain)

Question 23

what are the chances of withdrawal bleeding in each of
sequential regimen
combined regimen ?

Answer 23

sequential regimen : 80%

combined regimen : 20%