Menopause

Question 1

What is the definition of the menopause?

Answer 1

A woman’s last ever period. Average age 51.

Question 2

How long does the perimenopause last?

Answer 2

Approximately 5 years

Question 3

What is classed as a premature menopause?

Answer 3

40 years or less. Affects 1 % of women.

Question 4

What is oestradiol?

Answer 4

A steroid hormone secreted mainly by the ovary.

Ovaries stop producing at menopause

Question 5

What secretes Oestradiol?

Answer 5

Mainly the ovary

Also adrenals and testis.

Question 6

Describe the main hormonal changes in the menopause.

Answer 6

Oestradiol falls (due to ovarian insufficiency)
FSH rises

Question 7

What may cause a sudden menopause transition?

Answer 7

Oophorectomy
Chemotherapy
Radiotherapy

Question 8

What are the symptoms of the menopause?

Answer 8

Hot flushes/ night sweats (vasomotor)
Vaginal dryness/ soreness 
Low libido
Muscle and joint aches 
Mood changes/ poor memory—> possibly related to vasomotor symptoms affecting sleep

Question 9

What are the two types of hormone replacement therapy?

Answer 9

1. Local vaginal

2. Systemic oestrogen

Question 10

What are the contraindications to systemic HRT?

Answer 10

1. Current hormone dependant cancer: breast/ endometrium
2. Current active liver disease
3. Uninvestigated abnormal vaginal bleeding
4. Seek advice if previous VTE
5. Seek advice if previous breast cancer

Question 11

What are the contraindications for vaginal HRT?

Answer 11

Women taking aromatise inhibitor treatment for breast cancer

Question 12

What are the symptomatic treatments of the menopause?

Answer 12

HRT (systemic or vaginal)
SERMs
Clonidine or SSRI antidepressants 
Phytooestrogen herbs 
Non hormonal lubricants for vaginal dryness

Question 13

What is the andropause?

Answer 13

The ‘male menopause’
Testosterone falls by 1% a year after age 30
Fertility remains
No sudden changes

Question 14

What is primary amenorrhoea?

Answer 14

Never had a period.

Question 15

How common is primary amenorrhoea?

Answer 15

Affects 5% of girls

Question 16

What is secondary amenorrhoea?

Answer 16

Has had periods in the past but not in the last 6 months

Question 17

What are the possible causes of secondary amenorrhoea?

Answer 17

Pregnancy/ breast feeding 
Contraception related
Polycystic ovary syndrome 
Premature ovarian insufficiency 
Hypothalamic: stress, excess exercise 
Thyroid disease/ cushing’s
Raised prolactin 
Congenital adrenal hyperplasia 
Androgen secreting tumour 
Sheehans syndrome: pituitary failure 
Ashermans syndrome: intrauterine adhesions

Question 18

What factors are important to get when taking a history of someone with possible amenorrhoea?

Answer 18

Possibility of pregnancy 
Breastfeeding 
Medicines including contraception
Galactorrhoea
Acne/ hirsutism 
Weight change 
Exercise/ stress
Significant illness

Question 19

What is polycystic ovary syndrome?

Answer 19

Regular periods
Excess androgen (high levels of male hormones)
Ovaries become enlarged and contain many fluid-filled sacs that surround the eggs

Question 20

What are the symptoms of polycystic ovary syndrome?

Answer 20

Irregular periods
Difficulty getting pregnant 
Excessive hair growth
Thinning hair 
Acne

Question 21

What is the management of PCOS?

Answer 21

Weight loss/ exercise to BMI 20-25
Antiandrogens 
 - combined hormonal contraception 
- spironolactone 
- elfornithine cream reduces facial hair growth 
Endometrial protection CHC, mirena IUS