Menopause

Question 1

When is the menopause diagnosed?

Answer 1

After 1 year of amenorrheoa

Question 2

What hormone measurement can be used to diagnose the menopause?

Answer 2

Serum FSH level > 30 IU/l on 2 separate occasions = ovarian failure
(FSH levels peak around the time of the menopause)

Question 3

Which form of oestrogen is predominant in premenopausal women?

Answer 3

Oestradiol (E2)

Question 4

Where is oestradiol produced?

Answer 4

Ovaries

Question 5

What is the predominant form of oestrogen in post menopausal women?

Answer 5

Oestrone (E1)

Question 6

Where is oestrone produced?

Answer 6

From conversion of androgens in adipose tissue

Question 7

Which is more biologically active: E1 or E2?

Answer 7

E2

Question 8

What are the acute symptoms of the menopause?

Answer 8

Headache
Fatigue
Insomnia
Arthralgia
Dizziness
Hot flushes 
Night sweats
Poor memory
Poor concentration
Irritability
Low mood 
Anxiety
Reduced libido

Question 9

What makes hot flushes/night sweats worse?

Answer 9

High BMI

Smoking

Question 10

What are the medium term effects of the menopause?

Answer 10

Vaginal dryness/itch/burning
Dyspareunia
Sexual dysfunction
Prolapse
Dry skin
Hair thinning
Recurrent UTI
Urinary urge/incontinence

Question 11

What are the long term consequences of the menopause?

Answer 11

Cardiovascular disease
Cerebrovascular disease
Osteoporosis

Question 12

Why are the risks of cardiovascular, cerebrovascular disease and osteoporisis increased after menopause

Answer 12

Loss of protective effects of oestrogen:
Oestrogen reduces LDL, increases HDL, reduces cholesterol deposition and fat distribution
Loss bone density/architecture predisposing to fractures

Question 13

Which women require combined HRT as opposed to oestrogen only, and why?

Answer 13

Women with a uterus

Progesterone provides endometrial protection

Question 14

Which women is sequential HRT used in?

Answer 14

For use in peri-menopausal women with uterus

Question 15

How does sequential HRT work?

Answer 15

Oestrogen taken for 28 days
Progesterone taken for 10-14 days
Progestogen protects the endometrium and leads to a regular bleed
This regime mimics a normal menstrual cycle

Question 16

What is the maximum duration that sequential HRT can be used and why?

Answer 16

5 years

Increases risk of endometrial cancer

Question 17

When should continuous combined HRT be used?

Answer 17

This should not be started until 1 year after the LMP or aged 54
Should also be used after 2 years of sequential therapy if under the age of 54

Question 18

When should sequential combined HRT be used?

Answer 18

Perimenopausal under the age of 54

Question 19

What is tibolone and when is it used?

Answer 19

A synthetic steroid with weak oestrogenic, progestogenic and androgenic properties
Used for vasomotor, psychological and libido problems

Question 20

What is testosterone used for and when is it used?

Answer 20

Helps general feeling of well being and improves libido

Used following natural menopause or bilateral oophrectomy along with systemic oestrogens

Question 21

Is endometrial protection required with local oestrogen HRT?

Answer 21

No

Question 22

What are the benefits of HRT?

Answer 22

Reduced risk of colorectal cancer
Improvement of vasomotor symptoms
Prevention of osteoporosis

Question 23

What are the risks associated with HRT?

Answer 23

Breast cancer
Stroke
Venous thromboembolism
Endometrial cancer

Question 24

When are venous thromboembolism more common in HRT?

Answer 24

Within the first year of use

Question 25

What is premature ovarian failure?

Answer 25

Cessation of menses and complete/partial loss ovarian activity before the age of 45

Question 26

What are the long term consequenses of premature ovarian failure?

Answer 26

Bone loss
CVS and stroke risk
Cognitive decline/dementia
Infertility
 ↓ life expectancy

Question 27

How is premature ovarian failure treated?

Answer 27

Combined HRT or COCP
Testosterone patches
Additional vaginal oestrogen may be required