Menopause

Question 1

Menopause

Answer 1

Cessation of menstruation

Question 2

Climacteric (perimenopause)

Answer 2

The period around the menopause and at least the first year after it

Question 3

Post-menopause

Answer 3

12 months of no period

Question 4

Average age of onset of menopause in the uk

Answer 4

51

Question 5

Range of age of onset of menopause

Answer 5

48-52

Question 6

Premature menopause

Answer 6

Before 40 (1%)

Question 7

Cause of menopause

Answer 7

Age - depletion of primordial follicles

Question 8

Causes of premature menopause

Answer 8

Idiopathic
Iatrogenic
Chromosomal (fragile X syndrome, FMR1)
Autoimmune
Others

Question 9

Mechanism of menopause

Answer 9

Ovaries depleted of follicles
Decline of oestrogen production
Gradual decline with fluctuation over a few years
Gradual rise of FSH and LH (lack of negative feedback mechanism)

Question 10

What is the age of menopause decided by

Answer 10

Size of primordial pool

Question 11

Problems associated with premature menopause

Answer 11

Increased risk of mortality
Risk of cognitive dysfunction
Heart disease
Mood and sexual disorders
Bone mineral density
Autoimmune and thyroid disease

Question 12

Short term symptoms of menopause

Answer 12

Vasomotor
Psychological
Urogenital
Skin

Question 13

Long term risks of menopause

Answer 13

Osteoporosis
Cardiovascular disease

Question 14

Vasomotor

Answer 14

Hot flushes
Sweats: mainly night
Palpitations
Headaches

Question 15

Psychological

Answer 15

Irritability
Lethargy
Emotional lability
Forgetfulness
Loss of libido
Loss of concentration

Question 16

Urogenital

Answer 16

Vaginal dryness
Dyspareunia- due to dryness
Urethral syndrome - mainly later on in the absence of HRT

Question 17

Skin

Answer 17

Dryness of skin and hair
Brittle nails

Question 18

Osteoporosis

Answer 18

Decreased amount of bony tissue per unit volume of blood
Wrist, femoral neck and vertebrae
Bone remodelling is uncoupled
5% loss of trabecular bone per year

Question 19

Risk factors of osteoporosis

Answer 19

Race- European and Asian women
Nulliparity
Low body weight
Poor diet in childhood
Alcohol abuse
Heavy smoking
Steroids
Thyrotoxicosis, hyperparathyroidism, Cushing disease etc

Question 20

Cardiovascular disease- myocardial infarction, angina and cerebrovascular stroke

Answer 20

Equal risk to me by age 70
Cause unknown
Family history is a determinant factor
Other variables: obesity, diabetes

Question 21

Treatment of menopause

Answer 21

HRT
Sedatives and tranquillisers
Clonidine
Beta blockers
Maintaining pre-menopausal sexual activities
Calcium, vitamin D, calcitonin
Symptomatic treatment

Question 22

HRT- hormone replacement therapy

Answer 22

Oestrogen
Progesterone if uterus intact - to reduce risk of endometrial cancer
Different formats
Different doses

Question 23

HRT preparations

Answer 23

Oral
Skin patches
Vaginal cream
Skin cream
Nasal spray
Vaginal ring
Implants

Question 24

Long term risk of HRT

Answer 24

Cardiovascular (E):
- Slight increase in CVS (oral vs transdermal)
- IHD no increased risk but no benefit

Breast cancer (E + P vs E):
Increased by 2 per 1000 if taken for >5 years.
6/1000 for 10 years use.
12/1000 for 15 years use.

VTE (venous thromboembolism): 1-3 in 10,000 women in the first year.

Cancer:
Slight increase in ovarian cancer (seq. HRT).
Endometrial Cancer: if unopposed E2.

Question 25

Contraindications of HRT

Answer 25

Abnormal liver function
Obstetric cholestasis
Thromboembolic disease
Congenital dist. Of lipid metabolism
Hormone dependent tumours
Sickle cell anaemia

Question 26

Individualised symptomatic treatment

Answer 26

CBT
Testosterone
Local steroids - monitoring of ET
Complementary therapies
Lifestyle
Monitoring