Menopause

Question 1

Definition of menopause

Answer 1

No periods for 12 months due to absolute oocyte deficiency.

Question 2

Perimenopause

Answer 2

Symptoms before absolute menopause due to decreased oestrogen

Question 3

Perimenopausal symptoms

Answer 3

Hot flushes 
Night sweats 
Mood disturbance 
Vaginal dryness
Anxiety 
Decline in libido
Hair thinning 
Irregular periods

Question 4

Average age for menopause

Answer 4

51

Question 5

Early menopause/ primary ovarian insufficiency

Answer 5

Menopause before 40 yo

Question 6

Investigations

Answer 6

Bloods - FSH x 2 at least 4 - 6 weeks apart

Question 7

HRT types

Answer 7

Continuous

Sequential

Question 8

Types of sequential HRT

Answer 8

Regular periods - Oestrogen + Progesterone for 14 days every month

Irregular periods - Oestrogen + progesterone for 14 days every 3 months

Question 9

When can oestrogen-only HRT be given

Answer 9

If hysterectomy

Question 10

Side effects of HRT

Answer 10

Increases the risk of breast cancer

Headaches 
Breast tenderness 
Bloating 
Muscle cramps 
Irregular bleeding 
VTE - oral HRT not gel or patch

Question 11

Benefits of HRT

Answer 11

Alleviates menopausal symptoms
Better CVD outcomes
Decreases risk of osteoporosis
Reduces risk of UTI

Question 12

When are investigations done

Answer 12

If menopausal symptoms in women less than 45 yo

Question 13

Advice for menopause

Answer 13

Exercise at least 2.5hrs per week

Smoking cessation

Reduce alcohol and coffee intake

Mediterranean diet

Open window, wear thinner clothes

Vaginal lubricant

Question 14

Impact of menopause on hormones

Answer 14

Oestrogen and progesterone - low

LH and FSH levels - high

Question 15

Impact of low oestrogen

Answer 15

Increased risk of:

• CVD
• Stroke
• Osteoporosis
• Pelvic organ prolapse
• Urinary incontinence

Question 16

When can perimenopause and menopause be diagnosed

Answer 16

45+ yo

Question 17

When should women use contraception in relation to menopause?

Answer 17

For 2 years after the last menstrual period in women under 50

For 1 year after the last menstrual period in women over 50

Question 18

Side effects of the progesterone only depot injection

Answer 18

Weight gain

Osteoporosis

Question 19

Non-Hormonal Treatments for Menopausal Symptoms

Answer 19

Lifestyle changes - improving the diet, exercise, weight loss, smoking cessation, reducing alcohol, reducing caffeine and reducing stress

CBT

Clonidine - agonist of alpha-adrenergic and imidazoline receptors

SSRI antidepressants (e.g. fluoxetine)

Venlafaxine, which is a selective serotonin-norepinephrine reuptake inhibitor (SNRI)

Gabapentin

Question 20

Clonidine

Answer 20

Lowers blood pressure and reduces the heart rate

Helpful for vasomotor symptoms and hot flushes

Question 21

Side effects of clonidine

Answer 21

Dry mouth
Headaches
Dizziness and fatigue

Sudden withdrawal can result in rapid increases in blood pressure and agitation