Menopause

Question 1

Definition of menopause

Answer 1

Permanent cessation of menstruation characterised by at least 12 months of amenorrhoea

Question 2

What is typical age of menopause

Answer 2

45-55

Question 3

Definition of perimenopause

Answer 3

The period when symptoms of menopause start and continues for 12 months after LMP

Question 4

Name the 4 phases of menopause

Answer 4

1)Pre-menopause:
Typically starts at 40, slightly less oestrogen released and LH and FSH levels may rise but not always due to reduced negative feedback
Can lead to reduced fertility

2)Peri-menopause
The 12 mth transition phase
This phase ends when menopause is completed

3)Menopause
Permanent cessation of menstruation because follicles are no longer developed

4)Post-menopause
12 months of amenorrhea

Question 5

Presentation of menopause - 3

Answer 5

Vasomotor - hot flushes, night sweats

Sexual Dysfunction - vaginal dryness, reduced libido, orgasm issues, dyspareunia

Psychological - depression, anxiety, lethargy, brain fog

Question 6

Differentials of menopause - 3

Answer 6

Thyroid disease (hot flushes)

Depression

Premature ovarian insufficiency (below 45)

Question 7

How is menopause diagnosed

Answer 7

Diagnosis with no lab tests if:
- irregular periods/no period for 12 months
- 45-55 yrs old
- symptomatic

FSH test recommeded for diagnosis in women under 40yrs - FSH will be raised

Question 8

Management of menopause - HRT and give benefits and risks

Answer 8

HRT
Oestrogen and progestogens can be given orally, transdermally or topically
Benefits - vasomotor and urogenital symptom relief, reduced osteoporosis risk

risks - breast cancer, endometrial cancer (only is oest given alone) and VTE

Question 9

Management of menopause - non hormonal (4)

Answer 9

Lifestyle - regular exercise, weight loss, stress reduction, good sleep

SSRIs

CBT

Vaginal moisturisters