menopause

Question 1

what is menopause ?

Answer 1

the last menstrual period

Question 2

average age of menopause?

Answer 2

52

Question 3

what is peri menopause

Answer 3

transition phase from pre to post menopausal and the time in which symptoms are experienced

Question 4

why do you get reduced circulating levels of oestrogen and progesterone

Answer 4

ovaries become less sensitive to FSH and LH

Question 5

what happens to levels of FSH and LH?

Answer 5

they are increased as there is less oestrogen and progesterone

Question 6

why do you get Reduced proliferation of the endometrium, resulting in oligomenorrhoea and then eventually amenorrhoea?

Answer 6

reduced levels of oestrogen

Question 7

the ain biologically active form of oestrogen?

Answer 7

E2

Question 8

which is the oestrogen produced by the peripheral tissues such as adipose and adrenal glands?

Answer 8

E1

Question 9

why do you get proportional increased levels of E1?

Answer 9

as there is reduced E2

Question 10

what happens to the breast and vaginal tissue medium term?

Answer 10

atrophy

Question 11

what is vaginal atrophy called?

Answer 11

atrophic vaginitis

Question 12

long term complications of low eostrogen?

Answer 12

osteoperosis

increased risk of cardiovascular and cerebrovascular disease

Question 13

what investigation can you do to diagnose menopause?

Answer 13

serum FSH >430 twice, 6 weeks apart

Question 14

conventional management?

Answer 14

weight loss, smoking cessation, complimentary therapies

Question 15

synthetic steroid that can be used as an alternative to HRT and is associated with similar risks

Answer 15

tibolone

Question 16

routes of administration for HRT?

Answer 16

oral, transdermal patch, vaginal ring, injections, intrauterine (mirena)

Question 17

when do you use oestrogen only

Answer 17

only if patient has had hysterectomy

Question 18

why can oestrogen only not be used in patient with a uterus?

Answer 18

unnopposed oestrogen is too big a risk factor for endometrial cancer

Question 19

how can combined HRT be taken?

Answer 19

oral/patch/mirena coil

Question 20

combined HRT and need contraception?

Answer 20

mirena

Question 21

who gets sequential HRT?

Answer 21

peri menopausal women with a uterus

Question 22

what does the sequential regimen involve?

Answer 22

getting oestrogen for 28 days and progesterone for the later half of the cycle which mimics the natural production of these hormones

Question 23

what does progesterone do in sequential?

Answer 23

protects the endometrium and allows regular bleeds

Question 24

how long can you use the sequential HRT?

Answer 24

a maximum of 2 years due to risk of endometrial cancer

Question 25

when do you use continuous HRT?

Answer 25

post menopausal women with a womb or peri who have used sequential for 2 years

Question 26

what is post menopausal defined as?

Answer 26

LMP>1 year or age over 54

Question 27

do you get a monthly bleed on continous?

Answer 27

no monthly bleed after 6 months

Question 28

what can peri menopausal women use for a bleed free regimen ?

Answer 28

oestrogen only and mirena

Question 29

benefits of HRT?

Answer 29

symptom control reduced risk of colorectal cancer prevention and treatment of osteoporosis

Question 30

Risks of HRT?

Answer 30

VTE Stroke increased risk of breast, ovarian and endometrial cancer

Question 31

highest risk of VTE - which HRT?

Answer 31

combined

Question 32

risk of breast cancer only increased in use with ?

Answer 32

combined

Question 33

after stopping, when does risk of breast cancer go back to normal ?

Answer 33

after 5 years

Question 34

risk of endometrial cancer is only really seen in ?

Answer 34

oestrogen only

Question 35

risk of endometrial cancer in women on sequential and continuous?

Answer 35

risk reduced with sequential and eliminated with continuous

Question 36

increased risk of ovarian cancer?

Answer 36

small increase in risk with any HRT

Question 37

when do you get an increased risk of CVD in combined

Answer 37

if its started more than 10 years after the menopasue

Question 38

increased risk of alzheimers if started after age?

Answer 38

60