Menopause

Question 1

Signs and symptoms of menopause

Answer 1

1) Hot flashes/flushes (heat starting in chest and rising upwards lasting 3-4 min but up too 30 min (-/+ sweating + palp)
2) vaginal drysness/atrophy/dyspareunia/ dysuria/ increased UTI
3) sleep disturbances (2nd to night sweats)
4) mood disorders (depression/anxiety/irritability)
5) impaired cognition
6) somatic complaints (back pain/stify)
7) vertigo/headache
8) weight gain (avg 5lb)
9) sexual dysfunction

Question 2

Diagnose og menopause

Answer 2

12 month after final menstrual period
Premature if <40
Early if <45
No testing as such required for the Diagnosis

Question 3

When to investigate for Menopause

Answer 3

• If diagnosis unclear and not on hormones
• suspected menopausal symptoms <45 y/o

Question 4

What investigation to do to Dx menopause when needed

Answer 4

1) increased FSH > 30 mIU/ml (1st hormone to increase)
2) increase LH (later than FSH)
3) TSH, Prolactin, B-hCG
If estradiol < 20= menopause
* if on OCP, test day 7 of pill free time if decreased estradiol and increased FSH = menopause

Question 5

Who to consider for hormone therapy

Answer 5

• 1st line if <60/y, <10 yrs past menopause w bothersome vasomotor symptoms + no CI
• recommended for women w/ primary ovarian insufficiency or premature menopause without CI till anticipated menopause

Question 6

Small notes to hormonal therapy replacement

Answer 6

• initiating hormone therapy >10 yrs after memopause increased risk of cardiac events
• VTE risk is less in transdermal therapy and less if within 10 of menopause

Question 7

Side effects of systemic Estrogen

Answer 7

Breast tenderness
Uterine bleeding
N/V
H/A
Dizziness
VTE
CV event
Pruritus
Cholecystitis
Liver effects

Question 8

Contraindications for systemic Estrogen

Answer 8

Pregnancy
Abnormal vaginal bleeding
Breast/ovarian/endometrial CA
CAD
CVA
VTE
Livet Dz

Question 9

Contraindications for systemic progesterone

Answer 9

Abn Vaginal bleeding
Breast CA

Question 10

Breast cancer survivors and vasomotor sx

Answer 10

Use:
venlafaxine
Gabapentin
Paced breathing
CBT
Acupuncture

Question 11

Breast CA survivor W/ genitourinary issues

Answer 11

Lubricants
Moisturizers
Pelvic floor physiotherapy
* vaginal estrogen in consult w/ oncologist

Question 12

In HT what combination decreases risk of breast CA

Answer 12

Giving progesterone cyclic:
So min 12/14 days/mo
However increased risk of withdrawal bleeding