Menopause

Question 1

In Perimenopause FSH levels increase, why

Answer 1

Ovarian function decreases and so does oestrogen production. So FSH stimulates ovaries to produce oestrogen

Question 2

What is the normal age for menopause in the UK?

Answer 2

51

Question 3

What are the physical symptoms of menopause?

Answer 3

• hot flushes
• night sweats
• muscle pain
• heart palpitations
• skin/hair changes
• weight gain

Question 4

What are the psychological changes?

Answer 4

• anxiety
• low energy
• cognitive changes
• mood disturbances
• sleep disturbances

Question 5

What are the gynaecological symptoms

Answer 5

• vaginal dryness
• low libido
• urinary incontinence
• menstruation irregularity

Question 6

What is considered a red flag symptom in menopause

Answer 6

Vaginal bleeding

Question 7

Which medication can cause similar side effects to menopause symptoms

Answer 7

• opiates
• nitrates
• SSRIs
• CCB

Question 8

What are some differential diagnosis?

Answer 8

• anxiety
• panic attacks
• alcohol induced symptoms
• drug induces symptoms
• TB
• secondary amenorrhoea

Question 9

Complications of Postmenopausal women?

Answer 9

• CVD
• osteoporosis
• stroke

Question 10

Complications in perimenopausal women

Answer 10

• CVD
• osteoporosis
• T2DM
• TB

Question 11

Link between TB & Menopause

Answer 11

Hot flush and night sweats

Question 12

Define perimenopause

Answer 12

Last menstruation <1 year ago

Question 13

Define postmenopause

Answer 13

Last menstruation >1 year ago

Question 14

Oral, patches and gels for those who take oestrogen only

Answer 14

Oral - Elleste solo
Patches - Evorel (1 patch, twice weekly)
Gel - estrogel (1.5mg daily)

Question 15

Oral and patches for those on Sequential combined

Answer 15

Oral - Ellet’s duet
Patches - Evorel sequi (1 patch, twice weekly)
Gel - oestrogel + progesterone

Question 16

Oral, patches and gel for those on continuous combined

Answer 16

Oral - kilofem (OD)
Patches - Evorel conti (one patch twice weekly)

Question 17

HRT ADRs?

Answer 17

• headaches/migraines
• breast tenderness
• back pains
• bloating
• nausea
• diarrhoea
• Fluid retention
• leg cramps (oestrogen)
• hair loss

(Period like)

Question 18

HRT CI

Answer 18

• breast cancer
• oestrogen dependent cancer
• VTE
• atrial thromboembolism disease (mi, angina)
• liver disease
• pregnancy

Question 19

HRT risks

Answer 19

• breast, ovarian, endometriosis cancer
• stroke
• VTE
• CVD (not >65)

Question 20

How often should you monitor a patient on HRT

Answer 20

3 months then annually

Question 21

When would it be appropriate to stop HRT

Answer 21

• when risks outweigh benefits
• patient is ready to stop

Question 22

Who would be best for transdermal HRT

Answer 22

• risk of VTE
• high BMI >31
• preference oral
• on a hepatic indusing enzyme
• migraines
• lack of symptoms control with oral

Question 23

HRT prevents osteoporosis, how?

Answer 23

Osteoarthritis- thinning of bones

Oestrogen helps with bone health

Question 24

Cholecalciferol 400 unit dose can be taken to support bone health, what could you monitor

Answer 24

Plasma calcium conc

Question 25

If management with HRT is not appropriate what other drugs can help with vasomotor symptoms etc?

Answer 25

• pregabalin
• gabapentin
• SSRI
• clonodine

• CBT

Question 26

Which one of the previous drugs are also used in HTN

Answer 26

Clonidine

Question 27

Up in till how long is ullipristal appropriate to use after unprotected conception

Answer 27

<120 hours

Question 28

Up in till how long is levenogesterol appropriate to use after unprotected conception

Answer 28

<72 hours

Question 29

What is the dose of Alendronic acid for postmenopausal women

Answer 29

10mg once daily

= 70mg weekly

Question 30

What are the 2 first lines of bisphosphonates - oral

In post menopausal osteoporosis

Answer 30

Alendronic acid OR risedronate sodium

Question 31

How often in bone density screening recommended in postmenopausal women at average risk

Answer 31

2-3 years