Menopause

Question 1

wat is climacteric menopause

Answer 1

the bit leading up to the last period

Question 2

what is the average age of menopause

Answer 2

51

Question 3

when is early menopause

Answer 3

<45 years

Question 4

when is premature menopause

Answer 4

<40 years

Question 5

when is late menopause

Answer 5

> 54

Question 6

what are some causes of premature menopause

Answer 6

genetic
chromosomal
radio/chemo
removal of ovaries due to endometriosis

Question 7

how many ova at birth

Answer 7

1 million

Question 8

what does FHS and LH from the ant pit do

Answer 8

cause granulosa cells to secrete oestrogens

Question 9

what are oestrogens

Answer 9

collection of oestrogen like hormones such as estrodial

Question 10

what leads to menopause

Answer 10

absence of oestrogens

Question 11

what are some effects of oestrogen

Answer 11

secondary sexual characteristics 
hair distribution, body shape and fat distribution
effect on collagen
bone growth 
proliferates endometrium

Question 12

what are the three ways menopause can be diagnosed

Answer 12

symptoms
pattern of periods
blood tests - FSH and LH

Question 13

how is FSH and LH released

can a blood test for FHS and LH levels diagnose menopause

when is FHS and LH raised

Answer 13

released in pulsatile fashion

single raised levels do not confirm diagnosis, maybe is women has no uterus but not in isolation

raised poor to ovulation, stopping COCP or depo, raised breastfeeding or certain medication (SSRI)

Question 14

what are some physical symptoms

Answer 14

hot flushes
night sweats
palpitations 
insomnia 
joint aches
headaches

Question 15

how many women have hot flushes
how many have severe symptoms
how long do they last
how long does each one last for

Answer 15

60-80%
20%
2 years but 10% for 15 yrs
last 3-5 minutes

Question 16

what are hot flushes triggered by

Answer 16

anxiety, hot meals, change in temperature of the room or no trigger

Question 17

what are some psychological symptoms

Answer 17

mood swings 
irritability 
anxiety 
difficulty concentrating 
forgetfulness

Question 18

sexual symptoms of menopause

why do these occur

Answer 18

vaginal dryness due to withdrawal of oestrogen

reduced libido due to physical symptoms

libido can be stimulated by testosterone

Question 19

what are some later symptoms

Answer 19

frequency 
recurrent UTIs
dysuria 
incontinence 
dry hair and skin 
atrophy of breast and genitals

Question 20

what is perimenopausal DUB

Answer 20

irregular periods because eggs aren’t being released regularly anymore

Question 21

when does PMB occur

what should be done and why

Answer 21

bleeding a year after menopause

nees to be investigated with a pipelle biopsy as could be ovarian cancer

Question 22

conservative management of menopause

Answer 22

diet - processed food makes symptoms worse
weight loss
exercise - reduces symptoms 
lifestyle 
caffeine

Question 23

menorrhagia treatment

Answer 23

mefanamic acid is a NSAID reduced blood supply to the uterus

tranexamic acid anti fibrinolytic

progesterones - stabilises the lining of the womb and so its less likely to proliferate DEPO

IUS - releases low dose prog and is a contraceptive

endometrial ablation

hysterectomy

Question 24

HRT

Answer 24

oestrogen alone - can cause endometrial hyperplasia or endometrial cancer - so only if hysterectomy

oestrogen and progesterone - increases risk for breast cancer compared to oestrogen alone

topical and oral

Question 25

benefits for HRT

Answer 25

reduced osteoporotic fracture

reduced bowel cancer

Question 26

risks for HRT

Answer 26

VTE
CVA
breast cancer
gallbladder disease

Question 27

non HRT treatments

Answer 27

clonidine 
SSRIs
regelle
Yes
sylk

Question 28

when are non HRT treatments used

Answer 28

second line to HRT if breast cancer