Menopause

Question 1

Menopause Definition

Answer 1

lack of menses for 1yr

Question 2

Perimenopause Definition

Answer 2

period of time surrounding menopause (2-8 yrs preceding + 1 yr after last menses) characterized by fluctuating hormone levels, irregular menstrual cycles, and symptom onset.

Question 3

Menopause Types

Answer 3

• physiological
  * average age 51 yrs (follicular atresia)
  • premature ovarian failure
    
    • before age 40 (autoimmune disorder, infection, Turner’s syndrome)
  • iatrogenic
    
    • (surgical/radiation/chemotherapy)

Question 4

Menopause Clinical Features

Answer 4

• associated with oestrogen deficiency
  * vasomotor instability (tends to dissipate with time)
  * urogenital atrophy involving vagina, urethra, bladder
  * skeletal
  * skin and soft tissue
  * psychological

Question 5

Menopause vasomotor instability features

Answer 5

• hot flushes/flashes
• night sweats
• sleep disturbances
• formication
• nausea
• palpitations

Question 6

Menopause urogenital atrophy features (involving vagina, urethra, bladder)

Answer 6

• dyspareunia
• pruritus
• vaginal dryness
• bleeding
• urinary frequency
• urgency
• incontinence

Question 7

Menopause skeletal features

Answer 7

• osteoporosis
• joint and muscle pain
• back pain

Question 8

Menopause skin and soft tissue features

Answer 8

• decreased breast size

- skin thinning/loss of elasticity

Question 9

Menopause psychological features

Answer 9

• mood disturbance
• irritability
• fatigue
• decreased libido
• memory loss

Question 10

Menopause investigations

Answer 10

• Use absence of menses for 1 yr to diagnose

* decreased levels of estradiol (later)

Question 11

Menopause treatment

Answer 11

• goal is for individual symptom management
  
  • vasomotor instability
  • urogenital health
  • osteoporosis
  • decreased libido
  • cardiovascular disease
  • mood and memory

Question 12

Menopause vasomotor management

Answer 12

• HRT (first line)
• clonidine
• SSRIs
• venlafaxine
• gabapentin
• propranolol

Question 13

Menopause urogential health management

Answer 13

• lifestyle changes (weight loss, bladder re-training)
  * local estrogen replacement
  * surgery

Question 14

Menopause osteoporosis management

Answer 14

• 1000-1500 mg calcium daily, 800-1000 IU vitamin D, weight-bearing exercise, quit smoking
• bisphosphonates (e.g. alendronate)
• selective estrogen receptor modifiers (SERMs):
• – raloxifene - mimics oestrogen effects on bone, avoids estrogen-like action on breast and uterine cancer; does not help hot flashes
• HRT: second-line treatment (unless for vasomotor instability as well)

Question 15

Menopause decreased libido management

Answer 15

vaginal lubrication, counselling, androgen replacement (testosterone cream or oral supplementation)

Question 16

Menopause cardiovascular disease management

Answer 16

management of cardiovascular risk factors

Question 17

Menopause mood and memory management

Answer 17

• antidepressants (first line), HRT (augments effects)

Question 18

Menopause vaginal atrophy management

Answer 18

• local oestrogen
  * cream
  * vaginal suppository
  * ring
• lubricants

Question 19

HRT Contraindications

Answer 19

ABCD
A - Acute liver disease
B - Undiagnosed vaginal Bleeding
C - Cancer (breast/uterine)
D - DVT (thromboembolic disease)