Menopause

Question 1

What is menopause and when does it occur

Answer 1

The time of ovarian failure and cessation of menstrual period that occurs in women at a mean age of 51

Question 2

What molecule, released from the ovaries in the early menopausal transition starts to decrease why is this?

Answer 2

Levels of inhibin B are decreased due to a fall in follicular number

Question 3

What does the decline in inhibit B result in

Answer 3

an increase in serum GSH level due to a loss of the negative feedback effect of inhibit B on FSH secretion

Question 4

Describe the changes in estradiol with the menopause

Answer 4

Initially relatively preserved, possibly due to increased aromatase activity stimulated by the elevated FSH

Question 5

What happens to estradiol after menopause

Answer 5

It declines due to a depletion in ovarian follicles and so is not longer being secreted

Question 6

What do the ovaries continue to secrete and under what control

Answer 6

Androgens under the continued stimulation of LH

Question 7

How is menopause clinically diagnosed

Answer 7

amenorrhoea for 12 months in a woman over the age of 45

Question 8

Describe some menopausal symptoms

Answer 8

Hot flushes
urogenital symptoms: vaginal dryness, dysuria, frequency, stress incontinence and recurrent ITU
Mood changes and sleep disturbances

Question 9

What are some other causes of menstrual changes that must be ruled out

Answer 9

Pregnancy
hyperprolactinaemia
thyroid dysfunction

Question 10

What might atypical hot flushes and night sweats be associated with

Answer 10

medications 
phaeochromocytoma 
thyrotoxicosis 
carcinoid syndrome 
underlying infection 
malignancy

Question 11

What is the most effective treatment of rate relief of menopausal symptoms

Answer 11

HRT with oestrogen

Question 12

What must be added to the oestrogen in women who have not had a hysterectomy and why

Answer 12

Progestin - unopposed oestrogen can result in endometrial hyperplasia and carcinoma

Question 13

Who is HRT not recommended in

Answer 13

those with a previous history of:
breast cancer
Coronary heart disease
stroke or venous thromboembolism

those with risk factors for these conditions

Question 14

Describe the sequential cyclical regimen of HRT

Answer 14

oestrogen is given continuously and a progestin is added for the first 12-14 days of each month

Question 15

Describe the container combined regimen of HRT

Answer 15

Oestrogen and lower doses of a progestin are given on a daily basis

Question 16

Who generally prefer the cyclical regimen

Answer 16

younger women and newly post menopausal women

Question 17

Who generally prefer the continuous combined regimen

Answer 17

older women who do not want month withdrawal bleeds

Question 18

How long can a woman be on HRT for

Answer 18

1-3 years but generally no more than 5 years

Question 19

What should be given for hot flushes

Answer 19

Oestrogen continuous regime

Question 20

How is oestrogen given to treat hot flushes

Answer 20

Transdermal patch (side effect is a skin reaction)

Question 21

How do women come off of HRT

Answer 21

Some can come off abruptly but others need to taper down slowly

Question 22

What treatment can be given to women with mild urogenital symptoms

Answer 22

Regular vaginal moisturising agents and lubricants during intercourse

Question 23

How can low dose vaginal oestrogen be delivered

Answer 23

Tablet, ring or cream - depends on the patients choice

Question 24

What is the first line treatment for osteoporosis in postmenopausal women

Answer 24

Bisphosphonates (alendronate)

Question 25

What should postmenopausal women with osteoporosis receive

Answer 25

adequate calcium and vitamin D

Question 26

What information should a postemenopasual woman be given

Answer 26

the importance of relevant lifestyle measures including exercise and smoking cessation
fall prevention