Menopause

Question 1

what is it

Answer 1

cessation of menstruation

Question 2

What is the average age of menopause

Answer 2

51

Question 3

When is it diagnosed

Answer 3

after 12 months of amenorrhoea

Question 4

whAT IS perimenopause

Answer 4

period leading up to menopause characterised by irregular periods and sx e.g. hot flushes, mood swings, urogenital atrophy

Question 5

What symptoms make up early effects of menopause

Answer 5

vasomotor and generalise sx

Question 6

What are the vasomotor symptoms of menopause? when do they occur? how long do they last
why are they important

Answer 6

• hot flushes and night sweats
can begin before periods stop
• Last on average 2-7 years
• Impact on sleep (night sweats), mood and QOL

Question 7

What are generalised sx?

Answer 7

¥ Mood change/irritability
¥ Loss of memory/concentration
¥ Headaches, dry and itchy skin, joint pains
¥ Loss of confidence, lack of energy

Question 8

What are intermediate effects of menopause

Answer 8

vaginal atrophy
urinary problems (frequency, urgency, nocturia, incontinence, recurrent UTIs)
sexual problems (loss of libido, problems w orgasm, dyspareunia)

Question 9

What problems can vaginal atrophy cause

Answer 9

dyspareunia
cessation of sex
itching burning and dryness
PMB (be careful of cancer)

Question 10

What are late effects of menopause

Answer 10

osteoporosis
CV disease
dementia

Question 11

why is osteoporosis an important effect of the menopause?

Answer 11

increases risk of fractures (wrist, Colles’, hip and spine)

Question 12

What are the ix

give the results expected in menopause and why

Answer 12

1. FSH (2-5 days of cycle) - increased suggests fewer oocytes remaining
2. AMH - low levels - ovarian failure , gives direct measurement of ovarian reserve as produced by small ovarian follicles
3. TSH - check for adequate response to HRT
4. LH, oestradiol + progesterone
5. Bone density - DEXA (lumbar spine + hip)

Question 13

What HRT is given in women still w uteruses?why?

Answer 13

combined HRT

use of oestrogen only is a major RF for endometrial cancer

Question 14

What HRT is given for those w/o a uterus

Answer 14

oestrogen only therapy

Question 15

What HRT is given in pre/perimenopausal women

Answer 15

oestrogen and cyclical progesterone

Question 16

What HRT is given in postmenopausal women

Answer 16

continuous combined HRT

Question 17

how can progestogens be given

Answer 17

Progestogens can be given orally, transdermally and via Mirena

Question 18

when is HRT contraindicated?

Answer 18

Oestrogen dependent cancers (endometrial, ovarian, breast)
Past PE
Undiagnosed PV bleeding 
Increased LFT 
Pregnancy 
Breastfeeding 
Phlebitis

Question 19

what are SE of HRT?

Answer 19

Fluid retention
Bloating
Breast tenderness
Nausea
Headache
Leg cramps
Dyspepsia

Question 20

What are the risks associated w HRT, which regimens specifically?

Answer 20

Breast cancer - combined
Endometrial - oestrogen only
VTE - oral HRT
CVD - increases risk >60

Question 21

What is the duration of therapy ?

Answer 21

continue up to 5 yrs then stop to see whether sx recur w sufficient severity to warrant continuation
premature - until median age of natural menopause