Menopause

Question 1

Define Menopause

Answer 1

Amenorrhoea for 12 months

Question 2

Define Perimenopause/climacteric period

Answer 2

Declining ovarian function causing menopausal symptoms:

vasomotor, reduced libido, vaginal dryness, mood lability

Question 3

Pathophysiology of menopause

Answer 3

• Declining ovarian function causes decline in oestrogen production
• decreased oestrogen causes increase in FSH (greater than 20 u/L perimenopause and 40u/L postmenopause)

Question 4

Consequences of menopause

Answer 4

Short term
-vasomotor symptoms (DDx thyroid issue)
-atrophic vaginitis
-sleep and mood disturbance
-decreased libido
Long term
-decreased bone mineral density & Osteoporosis

Question 5

Primary prevention methods for osteoporosis

Answer 5

Weight-bearing exercise (3hrs + /week)
VitD3 and Ca (1200mg/day) supplements
avoid skeletal toxins (excess alcohol and caffeine)

Question 6

Diagnosis premature menopause

Answer 6

Less than 4 months of amenorrhoea under 40 y/o
FSH 40+ u/L on 2 occasions, 1m apart
exclusion of secondary causes of amenorrhoea
-PREGNANCY!!!!!!!!!
-prolactinaemia
-Thyroid disturbance
-outflow obstruction
*Smokers have onset of menopause ~2yrs earlier

Question 7

Factors affecting the age of onset of menopause

Answer 7

Genetic Factors
Smoking (2 yrs earlier on avg.)
Surgical Menopause
*Age of menarche has NO ASSOCIATION with age of menopause!

Question 8

Implications of premature menopause

Answer 8

Loss of fertility
higher risk of Cardiovascular disease
higher risk of osteoporosis
altered body image
high rate of depression
menopausal symptoms
HRT indicated at a lower age

Question 9

Contraindications to HRT use

Answer 9

Hx of DVT/PE 
Hx of Stroke
Migraine with Aura (risk of stroke?)
ER/PR positive breast cancer
Undiagnosed vaginal bleeding (? endometrial CA)
Recent AMI
Pregnancy

Question 10

Non hormonal treatment options for hot flushes

Answer 10

• gabapentin
• SSRI/SNRI (desvenlafaxine, citalopram)
• clonidine

Question 11

Hormonal management of hot flushes

Answer 11

HRT
Tibolone (CI in Breast CA, has progesterone activity so does not require progesterone combination)
(oestrogen MUST NOT be unopposed in the presence of the uterus: high risk of endometrial hyperplasia and CA!)