Menopause

Question 1

Blood test for menopause?

Answer 1

Unreliable

FSH usually gradual rise

Question 2

Menopause hormones?

Answer 2

Decreased estradiol/progesterone

Androgen same

Question 3

Premature menopause is when?

Question 4

Smoking and menopause?

Answer 4

1-2 years earlier if smoker

Question 5

Hysterectomy for menopause?

Answer 5

Reduced age of menopause

Question 6

Menopause cause?

Answer 6

Run out of oocytes

Question 7

Accelerated loss of ovarian primordial follicles at what age?

Answer 7

37

Question 8

Risk of irregular anovulatory cycles?

Answer 8

Prolonged unopposed estrogen
Endometrial hyperplasia and cancer
NEEDS investigations

Question 9

Consequences of menopause? Short term?

Answer 9

Vasomotor symptoms (hot flushes)
Vaginal dryness, atrophic vaginitis
Sleep disturbance
Mood disturbance

Question 10

Medium to long term consequences of menopause? More likely if early menopause

Answer 10

Bone density
Risk of #s
Alzheimer’s
Cardiovascular

Question 11

Ask what for menopause?

Answer 11

What is impacting them the most? Directs management

Question 12

What happens if you have irregular periods in the perimenopausal time?

Answer 12

Need to investigate, could be endometrial cancer, pregnant,

Question 13

When do hot flushes end?

Answer 13

50% Most women: will last 5-8 years

Question 14

What are skeletal toxin?

Answer 14

Excess alcohol and caffeine

Question 15

Iatrogenic causes of premature menopause?

Answer 15

Chemo or radiation for cancers

Question 16

When is early menopause?

Answer 16

40-45

Question 17

When is premature menopause?

Answer 17

Before 40

Question 18

Other reasons for premature menopause? Genetic?

Answer 18

Turner’s, fragile X

Autoimmune

Question 19

Dx of premature menopause?

Answer 19

Amenorrhoea greater than 4 months

Question 20

Dx of premature menopause?

Answer 20

FSH, E2 on two occasions
Prolactin, TFT bHCG
Karyotyping

Question 21

What is in HRT?

Answer 21

Estrogen to treat symptoms

Progesterone to protect endometrium

Question 22

Best way to give HRT?

Answer 22

Transdermal, less likely to get DVTs

Question 23

What to do with premature menopause HRT?

Answer 23

Take COC

Question 24

HRT used for how long?

Answer 24

Shortest time, lowest dose to take care of symptoms

Question 25

Oestrogen alone bad how?

Answer 25

Risk of trike
VTE, PE
Cholecystitis
Endometrial hyperplasia and cancer for woman with uterus

Question 26

Combined HRT risks?

Answer 26

Breast cancer IF >5 years

Question 27

Contraindications for HRT

Answer 27

Hormone sensitive cancers

Question 28

Tibolone is?

Answer 28

Weak estrogen

Question 29

What do no hormonal therapies change?

Answer 29

Only vasomotor symptoms

NOT depression, sleep, urogenital.

Question 30

What available non-hormonal therapies?

Answer 30

Gabapentin
SSRI/SNRI
Clonidine