Menopause

Question 1

Define menopause

Answer 1

Permanent cessation of menstruation in women aged over 45 as a consequence of ovarian failure and oestrogen deficiency, preceded by a 12 month period of amenorrhoea.

Question 2

Who is affected by menopause

Answer 2

Women aged between 45-55 with mean age of 52 in the UK.

Question 3

What is perimenopause

Answer 3

The 12 months of amenorrhoea succeeding last menstrual period before classification as menopause

Question 4

What are 3 classifications of menopause symptoms?

Answer 4

1. Vasomotor symptoms: hot flushes, night sweats
2. Sexual dysfunction: vaginal dryness, reduced libido, problems with orgasm, dyspareunia
3. Psychological symptoms: depression, anxiety, mood swings, lethargy, reduced concentration

Question 5

What are possible differentials?

Answer 5

Thyroid disease: symptoms include hot flushes, sweating, palpitations, changes in menstrual cycle

Depression: mood swings, lethargy, reduced concentration

Premature ovarian insufficiency: Usually in significantly younger people - hot flushes, night sweats, vaginal dryness, reduced libido

Question 6

What 2 investigations are required?

Answer 6

1. Pregnancy test: if sexually active + amenorhoea
2. FSH: Recommended in those <40 and can help in those 40-45. >30 IU/Lcan predict menopause after several months of amenorrhoea

Question 7

What are the components of HRT?

Answer 7

Oestrogens: these overcome oestrogen deficiency and can be given orally, transdermally, or topically.

Progestogens: required for endometrial protection from unopposed systemic oestrogens; can be oral, transdermal or intrauterine.

Question 8

How can HRT be administered?

Answer 8

cyclically (for perimenopausal women still having periods) or continuously (for postmenopausal women not having periods).

Question 9

What are benefits of HRT?

Answer 9

Relief of vasomotor symptoms, relief of urogenital symptoms, and reduced risk of osteoporosis

Question 10

What are risks of HRT?

Answer 10

Increased risks of breast cancer, endometrial cancer (if oestrogen given alone), and venous thromboembolism

Question 11

What are non-hormonal management options?

Answer 11

Lifestyle measures: regular exercise, weight loss (if overweight), clothing alterations, stress reduction, avoiding triggers (such as spicy foods, caffeine, smoking, and alcohol), and good sleep hygiene

Selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs)

Clonidine (an alpha-2 adrenergic receptor agonist)

Cognitive behavioural therapy (CBT)

Vaginal moisturisers for urogenital symptoms