Menopause

Question 1

The WHO has defined the ______ as signifying
the permanent cessation of menstruation, resulting
from the loss of ovarian follicular activity

Answer 1

menopause

Question 2

Premenopausal: up to ______ years before the

last menstrual period.

Answer 2

5

Question 3

_________ the presence of early
menopausal symptoms with vaginal bleeding (usually
irregular).

Answer 3

Perimenopausal:

Question 4

Postmenopausal: the phase beginning

_________ months after the last menstrual cycle.

Answer 4

12

Question 5

Osteoporosis is
usually addressed in the context of the menopause
because it is found mainly in postmenopausal middleaged
and elderly women and can be largely prevented
by correcting________

Answer 5

oestrogen deficiency.

Question 6

In the postmenopause phase, FSH
rises to levels _______times that of the follicular phase
of the cycle while ______ levels rise about threefold

Answer 6

10–15

LH

Question 7

Contraception is advisable for_______ after the
last period for women over 50 years and two years
for those under 50 years

Answer 7

12 months

Question 8

The modern treatment of HRT at the menopause
not only reduces climacteric symptoms and enhances
the quality of life in the short term but also reduces
the risk of
1
2
3

Answer 8

bowel cancer, osteoporosis and fractures

Question 9

Emphasis of the The Women’s Health Initiative study

Points to emphasise:

• there is no firm evidence of an increased risk of
breast cancer with use of HRT_______
• HRT cannot be recommended in _______
• women choosing to cease HRT should reduce
their dose _________

Answer 9

<5 years

asymptomatic menopausal women to prevent osteoporosis

gradually over 2–3 months

Question 10

In 2013, an international meeting formulated
a Global Consensus Statement on Menopause
Hormone Therapy (MHT). What is their endorsement?

Answer 10

A key recommendation
is that ‘MHT is the most effective treatment for vasomotor symptoms associated with menopause at
any age, but benefits are more likely to outweigh risks
for symptomatic women before the age of 60 years or
within 10 years after menopause

Question 11

HRT in menopause

If _______, the OCP cyclical HRT (noncontraceptive)
or progestogen-only regimens such as
LNG-IUD can be used.

If menopausal—use ______

Answer 11

perimenopausal

HRT.

Question 12

_________ and gels are the most favoured estrogen Tx `worldwide

Answer 12

Transdermal patches

Question 13

______ and ______ are usually restricted
to women who have mild menopausal symptoms
and a dry vagina, or who cannot tolerate parenteral
medication

Answer 13

Vaginal creams or tablets

Question 14

________ is given to women with a uterus and
may be given continuously or cyclically. If it is not
given, many women will develop hyperplasia of
the uterus and there is a 5–10 times increased risk
of endometrial cancer with unopposed oestrogen

Answer 14

Progestogen

Question 15

What and how is Progesteron Tx given for post menopausal women?

Answer 15

If given cyclically (postmenopausal) it
is given for the first to the fourteenth day of the
calendar month, generally as Provera or Primolut
N

Question 16

Progestogen alone can be given for menopausal

symptoms in a woman with an_______

Answer 16

oestrogen-dependent tumour

Question 17

Progestogens should be given in the smallest

possible dose, to prevent _______

Answer 17

endometrial hyperplasia.

Question 18

A progestogen must be used with oestrogen if the

woman still has a ________

Answer 18

uterus

Question 19

________ is usually reserved for women whose
libido does not improve with HRT and those with
a premature menopause but this indication is
controversial and it should be used with caution
because of the lack of data about adverse effects

Answer 19

Testosterone

Question 20

How to give Testosterone in menopausal women

Answer 20

If available it is given as an implant of 50 mg and will

last 3–12 months

Question 21

What to give in addition while on Testosterone Tx

Answer 21

An oestrogen implant of 50 mg should be given concurrently

Question 22

This is a selective tissue oestrogenic activity regulator
with combined oestrogenic, progestogenic and
androgenic properties that can be used as an excellent
alternative to conventional HRT in postmenopausal
women.

Answer 22

Tibolone

Question 23

Positive effects of Tibolone are on 
1
2
3
4

Answer 23

vasomotor and urogenital symptoms, sexual function, bone density and fracture risk

Question 24

When is Tibolone given?

Answer 24

It should be considered for women who

are surgically postmenopausal or who have not had a natural menstrual bleed for at least 12 months.

Question 25

AE of Tibolone

Answer 25

Adverse effects with breakthrough bleeding and

virilisation are a concern

Question 26

Dose of Tibolone

Answer 26

Dose: tibolone 2.5 mg (o) daily

Question 27

The main absolute contraindications of HRT are:

Answer 27

active oestrogen-dependent neoplasms, such
as endometrial and breast cancer, deep venous
thrombosis, acute thrombophlebitis and undiagnosed,
abnormal vaginal bleeding

Question 28

HRT is protective for_____ but not ____

Answer 28

bowel cancer

ovarian cancer

Question 29

It must be emphasised that HRT, especially the_______, is not a contraceptive.

Answer 29

combined

sequential formulation

Question 30

The main short-term

risk of oral HRT in women aged 50–59 is _____

Answer 30

venous

thromboembolism

Question 31

How to manage premenstrual syndrome

Answer 31

decrease progestogen dose or change to alternative progestogen

Question 32

What is the cause of Nausea and breast disorders in postmenopausal women?

Answer 32

initial sensitivity to oestrogen

Question 33

How to manage nausea and breast DO?

Answer 33

reduce oestrogen to starting or low dose or use intravaginal oestrogen

Question 34

Heavy bleeding
Action: _______

Breakthrough bleeding
Action: ________

Irregular bleeding
Action: _______

Intolerance of bleeding
Action: use continuous regimen

No bleeding
Action: reassure that this is not a problem

Answer 34

decrease oestrogen

increase progestogen

investigate + endometrial sampling

Question 35

A useful working rule is to aim for treatment for a
maximum of ______and then review with an aim of
using HRT for _______ if appropriate for that person

Answer 35

2 years

5 years

Question 36

Current evidence is that combined oestrogen and
progestogen therapy will not increase the risk of
breast cancer for up to _______ and oestrogenonly
therapy will not increase risk for at least
_____

Answer 36

5 years of use,

7.2 years

Question 37

Vaginal dryness

The first-line therapy is a non-hormonal preparation
such as _______. If these are ineffective,
_________ preparations can be
useful,

Answer 37

Replens or K-Y Gel

low-dose vaginal oestrogen