Menopause

Question 1

What are the definitions of premenopause, perimenopause and postmenopause?

Answer 1

Premenopause: regular periods, perimenopause: irregular periods (last period was within the last year), postmenopause: no periods >12 months

Question 2

What is the average age of menopause in UK?

Answer 2

Around 51

Question 3

Approximately 1% of women enter menopause prematurely and have premature ovarian insufficiency. Under what age is it considered POI?

Answer 3

<40

Question 4

Approximately 5% of women experience early menopause. What age group is it considered early?

Answer 4

40-44

Question 5

What percent of women have symptoms that can be severe and on average how long do they last?

Answer 5

85% of women and 7.4 years

Question 6

When are menopause symptoms most severe?

Answer 6

Late peri- and early postmenopause

Question 7

What are the main 3 symptoms of menopause?

Answer 7

Mood swings, night sweats and hot flushes

Question 8

List some more unknown signs of menopause.

Answer 8

Anxiety, depression, painful sex, loss of libido, lack of energy, pins and needles, insomnia, palpitations, weight gain, dry skin and hair, brain fog

Question 9

In women >45 years, no routine FSH test is necessary. When is the exception to this?

Answer 9

Women aged >50 on hormonal contraception who do not want to continue until the age of 55

Question 10

FSH levels are measured confirm a diagnosis of peri-menopause in two groups of women, what tests are carried out and what two groups?

Answer 10

FSH levels x2 (6 weeks apart) in women >45 with atypical symptoms and in women between 40-45 with menopausal symptoms and/or iatrogenic amenorrhoea

Question 11

FSH, E2, TFT, glucose, prolactin and FAI should be checked in women with symptoms of what age?

Answer 11

In women <40

Question 12

Chromosomes should be checked to exclude autoimmune disorders in women with menopausal symptoms under what age?

Answer 12

<35

Question 13

When should you consider therapeutic trial of HRT?

Answer 13

In symptomatic patients, consider it independent from blood results and/or amenorrhoea

Question 14

What are non-hormonal treatments available for menopause? Few trials done

Answer 14

Herbal medicine: St. John’s Wort, Black Kohosh, Sage etc
Medical: antidepressants SSRIs/SNRIs, gabapentin
Complementary: acupuncture, homeopathy, aromatherapy

Question 15

Benefits of HRT?

Answer 15

Symptom relief particularly vasomotor, improvement of low mood associated with perimenopause, improvement of sexual function, decreased risk of osteoporosis & CVD if <60, prevention and treatment of urogenital/vulvovaginal atrophy

Question 16

Risks of HRT?

Answer 16

Increased risk of breast cancer, VTE and CVD if >60

Question 17

What is antoher name for urogenital/vulvovaginal atrophy?

Answer 17

Genitourinary syndrome of the menopause

Question 18

List 5 contraindications to HRT

Answer 18

Hx of breast cancer, coronary heart disease, TIA or previous stroke, unexplained vaginal bleeding, active liver disease

Question 19

If hysterectomy or mirena in situ, estrogen only can be given. This can be oral or transdermal. What are the 2 oral meds and what are the 3 transdermal?

Answer 19

Oral: estradiol or conjugated equine estrogens + Transdermal: estradiol gel, patch or spray

Question 20

If no hysterectomy or mirena in situ, estrogen and progesterone must be given together for HRT. If perimenopausal what kind of therapy is given and if postmenopausal what kind of therapy is given?

Answer 20

Perimenopausal: cyclical therapy (progesterone cyclical) + postmenopausal: continuous combined

Question 21

What is treatment for those with POI or early menopause?

Answer 21

HRT until the average age of menopause (51) + continue with contraception!

Question 22

HRT can be gradually reduced or immediately stopped and depends on what patient wants. True/false

Answer 22

True

Question 23

WHat are the benefits of transdermal over oral HRT?

Answer 23

Carries low/no increased VTE risk, is better for symptom control and associated with less CVD risks

Question 24

When would transdermal HRT be indicated?

Answer 24

Individual preference, poor symptom control with oral HRT, GI disorder affecting oral absorption, increased VTE risk, variable blood pressure control

Question 25

What are some side effects of HRT? (Estrogenic)

Answer 25

Bloating, breast enlargement, breast tenderness, fluid retention, headaches/migraine, leg cramps, mood swings, nausea

Question 26

What are some side effects of HRT? (Progestogenic)

Answer 26

Acne, anxiety, bloating, breast tenderness, depression, headaches/migraine, hirsutism, lower abdo/pelvic/back pain, mood swings

Question 27

When can contraception be stopped in perimenopausal women aged 40-49?

Answer 27

2 years after last natural menstrual period or 2 years after 2 results of FSH > 30IU/I taken at least 4-6 weeks apart

Question 28

When can contraception be stopped in perimenopausal women >50 yrs?

Answer 28

1 year after last natural menstrual period or 1 year after 1 result of FSH of >30IU/I

Question 29

When can contraception be stopped in perimenopausal women aged >55?

Answer 29

Contraception can be stopped even if still having periods cos oocytes quality poor