Menopause

Question 1

What is the menopause?

Answer 1

Cessation of menstruation -> >12months of amenorrhoea, average age is 51yo

Question 2

What can induce the menopause?

Answer 2

Oophorectomy

Question 3

What is the perimenopause and what features a typically present during this time?

Answer 3

Period of time leading up to the menopause:

• Irregular bleeds
• Classic symptoms:
  
  • Hot flushes
  • Mood swings
  • Urogenital atrophy

Question 4

What does the lack of (E) cause during the perimenopause?

Answer 4

^ FSH and ^LH due to disinhibition of the pituitary.

This lack of (E) is due to there being no follicles left in the ovaries.

Question 5

What are the short-term effects of the menopause?

Answer 5

Vasomotor symptoms:
- Hot flushes/sweating
Generalised symptoms:
- Fatigue
- Mood change
- Headaches
- Dry itch skin
- Joint pains

Question 6

What are the medium-term impacts of the menopause?

Answer 6

Urogenital atrophy:

• Dyspareunia
• recurrent UTIs
• PMB (always investigate)

Urinary incontinence and vaginal prolapse

Question 7

What are the long-term effects of the menopause?

Answer 7

Osteoporosis - reversible with (E) HRT

Cardiovascular disease:

• adverse changes in lipids
• increase in incidence of coronary heart disease

Dementia (esp. in early menopause)

Question 8

Give 2 benefits of HRT:

Answer 8

• Symptomatic relief of menopause

- Bone mineral density ^ (prevents risk of NOF#)

Question 9

What does NOF# mean?

Answer 9

Neck of femur fracture

Question 10

Give 4 risks with HRT:

Answer 10

1) Increases breast caner risk:
- (P) +(E) ^ risk
- ^ risk related to HRT duration

2) VTE (venous ThromboEmbolism):
- Further RF: obesity, FHx, thrombophilia

3) Cardiovascular disease
4) Stroke (only oral HRT)

Question 11

When should HRT be stopped/not given?

Answer 11

• If early or locally advanced breast cancer is diagnosed

- When the patient has Hx of breast cancer

Question 12

If a patient has had a hysterectomy or has a mirena coil in situ, what HRT regime should be given?

Answer 12

(E2) Estradiol - either oral or dermal

Question 13

If a patient has an intact uterus and is post-menopausal, what HRT regime should be given?

Answer 13

Continuous combined ((P) + (E)) - patch/oral.

Question 14

If a patient has an intact uterus and is perimenopausal, what HRT regime should be given?

Answer 14

Sequential - oral/patch

Question 15

If it has been less than 12months since the the patients last menstual period (LMP), what HRT medication shouldn’t be given?

Answer 15

COCP or Tibolone (steroid which has both Oestorogenic and progestogenic properties)

Question 16

Give 4 indications for use of HRT patches over oral:

Answer 16

• Gastric upset
• If steady absorption needed - epilepsy/migraine
• If ^ risk of VTE
• Older women with ^ HRT risks

Question 17

What is premature ovarian insufficiency (POI)?

Answer 17

Menopause <40yrs

Question 18

List 4 natural causes of POI:

Answer 18

• Chomosome abnormalities
• Enzyme deficiencies
• Autoimmune disease
• Inhibin B mutations

Question 19

List 3 iaratogenic causes of POI:

Answer 19

• Surgery
• Chemotherapy
• Radiation

Question 20

How is POI diagnosed?

Answer 20

• Amenorrhoea for >4months

- FSH >25 iu/L -> 2x samples, >4 weeks apart

Question 21

What is the mainstay treatment for POI?

Answer 21

(E) replacement:

• HRT
• COC pill

Question 22

How long after going through the menopause is one fertile for?

Answer 22

• 2 year if <50

- 1 year if >50