MENOPAUSE

Question 0

Differential diagnoses for menopause?

Answer 0

Hyperthyroidism - oligomenorrhoea, sweating and mood changes
Phaechromactyoma - sweating, palpitations

Question 1

What is menopause? Peri menopause? Average age? Risk factors for early? Early menopause? Premature menopause? What can cause premature ovarian failure?

Answer 1

Retrospective diagnosis made after 12 months of absent LMP

Peri menopause = 4 years preceding menopause

Average age 51

FHx
Smoking
Hysterectomy
Chemotherapy

Early = < 45
Premature = < 40
Autoimmune disorders, infection, turners syndrome
Iatrogenic - surgical/chemo/radio

Question 2

S + S?

Answer 2

Irregular menstrual cycles
Vasomotor
- hot flushes, sweating, chills + shivering 
- headaches
- light headed 
- palpitations 

Locomotor

• arthralgia
• myalgia

Sexual

• decreased libido
• Atrophic vaginitis (pruitus, dysparenia)

Psychological

• disturbed sleep
• mood e.g. New onset depression

Question 3

What are long term effects of oestrogen deficiency?

Answer 3

CVD 
OP 
Dementia (controversial) 
Fat: more fat and less lean mass
Skin: less collagen, more wrinkling 
Osteoarthritis

Question 4

Rx? Why HRT transdermal

Answer 4

Non-pharm
Diet: calcium and vit d 
Exercise .5hours per day 
Maintain weight
Alcohol <2sd per day 

Pharm - HRT
For symptomatic relief not prevention 
Duration for 5 years then review, if premature HRT until natural age of menopause 
Also venlafaxine, gabapentin, clonidine 
LESS THROMBOGENIC THAN PO

Question 5

Contraindications and SE’s?

Answer 5

Contraindications

• 10 years since menopause
• high risk of VTE
• poorly controlled HTN
• breast or gynae cancer

Acute liver disease
Bleeding vagina undiagnosed
Cardiovascular, cancer (uterine and breast)
DVT

SE’s

• PV bleeding in 1st 6 months
• breast tenderness if high dose started

Question 6

Benefits of HRT? Risks?

Answer 6

OP prevention/delay
Sexual dysfunction
Heart disease: may possible protect heart
Dementia

Increased breast cancer risk
Ovarian cancer
VTE