Menopause

Question 1

What non hormonal treatments are available for osteoporosis?

Answer 1

Vit D supps for those at risk of low sunlight exposure
Bisphosphonates

Question 2

What is the MOA of bisphosphonates?

Answer 2

inhibits osteoclast activity

Question 3

What is the definition of premature ovarian insufficiency?

Answer 3

Criteria - rule of 4s
- Oligo/amenorrhoea for 4 months
- FSH >25 iU/L on 2 occasions more than 4 weeks apart
- age <40 y/o

Question 4

What is the incidence of POI/POF?

Answer 4

1:100 (by age 40)
1:250 by age 35

Question 5

Categorise the causes of POI into 5 groups

Answer 5

genetic
immunologic
infection
metabolic
iatrogenic

Question 6

List 4 genetic causes of POI? can be broad

Answer 6

X monosomy
X trisomy
Deletions
Translocations

Question 7

List 5 immunologic causes of POI/POF

Answer 7

Hypothyroid
Addisons
Diabetic
Coeliac
APS 1 and 2

Question 8

Give 3 examples of infection associated with POI

Answer 8

Mumps
TB
Malaria

Question 9

Give 2 examples of metabolic problems that cause POI/POF

Answer 9

17 Hydroxylase deficiency
Galactosaemia

Question 10

Give 3 examples of iatrogenic cause of POI/POF

Answer 10

ovarian surgery
chemotherapy
radiotherapy

Question 11

list the 5 cornerstones of POI treatment

Answer 11

MHT is the most effective treatment for alleviating VMS
Body identical hormones should be used where possible
Contraception should be discussed
Transdermal therapy should be chosen where possible
WHI data does not apply for tx of POI

Question 12

What are the fertility options with POI

Answer 12

ovulation occurs in 25% of cases
1-10% of cases will have spontaneous pregnancy
no evidence for ovulation induction
oocyte donation has a 50% pregnancy rate

Question 13

What is the maternal mortality rate for someone with Turners syndrome

Answer 13

3%

Question 14

What is the association between cognition and age at menopause

Answer 14

early age at surgical menopause is associated with a faster decline in cognitive function
associated with increased Alzheimer’s pathology (neuritic plaques)

Question 15

What are the risk factors that add to the fracture risk for patients who have POI?

Answer 15

T1DM
Low BMI
Fam h/o fracture
smoking
ETOH abuse
sedentary lifestyle
Rheumatoid arthritis

Question 16

What are three autoimmune conditions associated with POI?

Answer 16

AI thyroid disease (15-20%)
Diabetes (3%) Addisons (3%) Polyglandular syndromes (3%)

Question 17

What regimen of MHT would you give to reproductive age woman with POI?

Answer 17

2mg estradiol orally
50microgram estradiol transdermally
+ progesterone

Question 18

What is the incidence of symptomatic menopause that causes diminished quality of life?

Answer 18

60%

Question 19

List 3 tools for diagnosis of osteoporosis

Answer 19

• fracture histroy
• DXA bone densitometry
• FRAX score

Question 20

list 5 relative contraindications to MHT

Answer 20

H/o breast or endometrial cancer
undiagnosed vaginal bleeding
h/o CHD or VTE
active liver disease
untreated HTN

Question 21

Is family history of breast cancer a contraindication to MHT?

Answer 21

No

Question 22

List 2 breast cancer associated relative contraindication to MHT

Answer 22

• breast cancer survivors
• women with BRCA mutation without risk reducing surgery

Question 23

A woman presents wanting MHT but concerned about breast cancer risk, what can you advise her?

Answer 23

• use of estrogen + progesterone in the use of women with an intact uterus is associated with an increased risk of breast cancer RR 1.2 but no chance in mortality
• use of estrogen alone in a woman following hysterectomy associated with a lower risk of breast cancer HR 0.78 and a lower risk of breast cancer mortality HR 0.6