Menopause

Question 1

Underlying cause of the menopause

Answer 1

Depletion of ovarian follicles leading to decreased oestrogen and progesterone levels

Question 2

Definition of menopause

Answer 2

A retrospective diagnosis made after 12 months amenorrhoea

Question 3

Early menopause

Answer 3

Menopause between age 40-45

Question 4

Premature menopause

Answer 4

menopause before 40

Question 5

Causes of premature menopause (4)

Answer 5

Radiation-induced
Chemotherapy-induced
Surgery-induced e.g. oophorectomy
treatment with GnRH analogues e.g. goserelin

Question 6

Factors which may contribute to early/premature menopause (5)

Answer 6

Smoking, low SES, age at menarche, parity, BMI

Question 7

main symptoms of the menopausal transition

Answer 7

vasomotor- hot flushes and sweats
urinary/genital symptoms- dryness, dyspareunia, recurrent UTI
sleep disturbance
Mood changes
Loss  of libido
Brittle nails, thin skin, hair loss

Question 8

Investigations in menopausal women (5)

Answer 8

FSH
TFTS
Blood glucose
Up-to-date cervical screening and mammogram
Possible pelvic ultrasound

Question 9

Diseases associated with post-menopause (5)

Answer 9

osteoporosis
CV disease
redistribution of body fat
Urogenital atrophy
Alzheimers disease

Question 10

Recommended calcium intake for peri/postmenopausal women

Answer 10

700mg/day

Question 11

Indications for HRT (2)

Answer 11

Relief of vasomotor symptoms in fully-informed women with no contraindications and a favourable risk:benefit ratio.
In women with premature/early menopause for relief of symptoms and bone mineral preservation

Question 12

Benefits of HRT (5)

Answer 12

Reduction in vasomotor symptoms
Improvement in quality  of life
Improvement in urogenital symptoms
Reduction in osteoporosis risk
?protection against Alzheimer's

Question 13

Risks of HRT (4)

Answer 13

Increased risk of vte, breast cancer, endometrial cancer, stroke

Question 14

The risk of which adverse effects of HRT are a) increased and b) decreased by inclusion of a progestogen?

Answer 14

a) breast cancer, VTE

b) endometrial

Question 15

How long does the risk of breast cancer take to return to normal after cessation of HRT?

Answer 15

5 years

Question 16

Contraindications to HRT (6)

Answer 16

Pregnancy/breastfeeding
Active angina/previous MI
Previous VTE
Suspected, current or past breast cancer
Endometrial cancer
Active liver disease with deranged LFTs

Question 17

Which type of HRT is most suitable for

a) without a uterus
b) women who still have a period
c) post-menopausal women with a uterus

Answer 17

a) oestrogen-only, continous HRT
b) cyclical combined hrt
c) continuous combined HRT

Question 18

What is an option for a patient who still desires contraception?

Answer 18

Mirena IUS, with added oestrogen in tablet/gel/patch form

Question 19

What is a good option for a patient whose primary concern is atrophic vaginitis?

Answer 19

Topical oestrogens

Question 20

Oestrogenic side effects (5)

Answer 20

Breast tenderness, leg cramps, bloating, nausea, headaches

Question 21

Progesterone side effects (5)

Answer 21

PMS-like symptoms, breast tenderness, backache, pelvic pain

Question 22

What is the NICE guidance relating to herbal/complementary treatments such as red clover?

Answer 22

These arent regulated and quality may be variable;also not enough evidence to state that they are safe in women with oestrogen-dependent cancer e.g. breast, endometrium

Question 23

Alternative drugs to HRT for vasomotor symptoms (2)

Answer 23

GABA analogues e.g. gabapentin

SSRIs e.g. citalopram