Menopause

Question 1

define menopause

Answer 1

last menstural period 12 months ago
-retrospective diagnosis

Question 2

average age of menopause in uk

Answer 2

52

Question 3

what is defined as premature menopause

Answer 3

under 40yo
-result of prematre ovarian insufficiency

Question 4

define perimenopause

Answer 4

time arounnd the menopause, where women may be experiencing vasomotor symptoms and irregular periods

Question 5

what causes menopause

Answer 5

lack of ovarian follicular function
-resulting in changes in the sex hormones associated with the menstrual cycle
-oestrogen and progesterone levels are low
-LH and FSH are high in response to absence of negative feedback from oestrogen

failing follicular development means ovulation does not occur and without osteogen the endometirum does not develop leading to lack of menstruation

Question 6

describe some perimenopausal symptoms 8

Answer 6

hot flushes

emotional labilty or low mood

premenstrual syndrome

irregular periods

joint pains

heavier or lighter periods

vaginal dryness and atrophy

reduced labido

Question 7

what conditions are menopausal women at an increased risk of due to lack of oestrogen 4

Answer 7

CVD and stroke

oestoporosis

pevlic organ prolapse

urinary inctoninence

Question 8

how can diagnosis for menopasue be made

-when would further testing be recommended for menopausal women and state that test

Answer 8

without any investigatiosn in women over 45yo w typical syx

-conisder FSH blood test if:
-wopmen under 40 suspected of premature menopause
-women aged 40-45 w menopausal syx or a change in menstural cycle

Question 9

other causes of menopause 6

Answer 9

surgical removal of ovaries

radio/chemo

hysterecomty w conservation of ovaries

smoking

deletion of X chromone 45XO

fragile X pre-mutation

Question 10

vasomotor syx of menopause 2

Answer 10

hot flushes

night sweats

Question 11

what affects do menopause have on the vagina and what are their consequences 4,5

Answer 11

affects
- epithelium thinner
-intermediate cells replaced w superficial
-secretions diminish
-pH decreases

consequences
-vaginal drynes
-dysparenuia and sex dysfunction
-relationship breakdown
-gneral discomft
-trauma and bleeding

Question 12

what affects do menopause have on the urinary tract and what are their consequences 1,4

Answer 12

effects- urethral mucosa atrophic

consequneces
-frequnecy
-dysuria
-incontinence
-recurrent UTI

Question 13

what affects do menopause have on the pelvic floor and what are their consequences 3,1

Answer 13

effects
-decreased blood supply
-decreased tone
-increased relaxation

consequence
-uterovaginal prolapse

Question 14

effects of menopause on mood 6

Answer 14

depresion

irritabilitu

anxiety

memory

sleep distrubance

alzheimers

Question 15

state the natrual oestroegns native to humans 4

Answer 15

17b-oestradiol (E2)

oestrone (E1)

oestriol (E3)

estetrol (E4)

Question 16

how are oestrogen replacement therapies commonly given 3

Answer 16

oral

transdermal patch

pessaries

Question 17

why is oestreogn alone unsafe as a hormone replacement therapy
-what is given in combination
-how frequently is HRT prescribed

Answer 17

not given alone as reports of incresaed endometrial carcinomas

given with progesterone

cyclical
-oestradiol E and progesterone for 2 weeks then only oestradiol for 2 weeks - then repeat

Question 18

treatment of urinary incontinence in menopausal women

Answer 18

no evidenec of local oestrogen

-instead recommend weight reduction, supervised pevlic floor muscle training and bladder training and antimuscarinics

Question 19

what factors affect a menopasuals womens chance of getting oestoporosis 2

Answer 19

the amount of bone they have when they reach menopause

how fast they lose bone after they reach menopause

Question 20

how are menopausal women assessed for oestoporosis risk 1

Answer 20

FRAX- WHO facture risk assessment tool

Question 21

how does HRT affect CVD and stroke risk

Answer 21

decreased risk of CVD

possible incresed risk of stroke

Question 22

regarding the use of HRT and weighing the risks versus benefits - what is the consensus

Answer 22

benefits are more likely to outweigh risks for symptomatic women before the afe of 60 or within 10 years after menopause

Question 23

alternatives of HRT for vasomotor symptom in menopause

Answer 23

prescribed- clonidine( has lots of side effects) , SSRI, gabapentin

alternative- acupuncture, lifetsyle, stellate ganglion blockade

CBT- shown to be VERY effective

Question 24

when do women stil need contraception if approaching menopause age

Answer 24

two years after last menstural periond in women under 50

one year after last menstrual period in women over 50

*-hormonal contracetives don’t affect menopause but may suppress/mask syx making it difficult to dx menopause

Question 25

what type of contraception is not recommneded in women approaching menopause and why

Answer 25

COCP can be used up until the age of 50 but not after

due to increase risk of gynae cancers, CVD risk and increased VTE risk

Question 26

what unique side effects doe sthe progesteone depot injection have and why is this important

Answer 26

causes wiehgt gain adn reduced bone minral denisty (oestoporosis)

-unique to depot
-oestooporosis risk makes it unsuitable for women over 45

Question 27

benefits of E+P HRT

Answer 27

reduced flush frequency
reduced flush severity
improves vagainal syx and sexual dysfunction

Question 28

non-hormonal Mx of vaginal menopausal syx
-who might use

Answer 28

vaginal moisturriesres

-women w hormone sensitive cancers or who do not wish to use oestradiol

Question 29

how is the endometrium affected by unilateral oestorgen HRT

-how is this managed

Answer 29

assoc w significant risk of endometrial hyperplasia

-addition of progesterone