Menopause

Question 1

define menopause

Answer 1

last ever period

Question 2

what is the climacteric?

Answer 2

symptoms associated with the menopause ie hot flushes

Question 3

when might you get an early menopause?

Answer 3

chemotherapy
infection
FH
ovariectomy
POF

Question 4

average age of menopause?

Answer 4

51 yrs

Question 5

late menopause is onset at >_years

Answer 5

54

Question 6

premature menopause is onset at

Answer 6

40

Question 7

what does oestrogen do?

Answer 7

proliferates endometrium -> periods
secondary sexual characteristics
hair distribution/body shape/fat distribution
effect on collagen
bone growth

Question 8

why dont you check LH and FSH if menopause is suspected?

Answer 8

its released in a pulsatile fashion so a single raised level doesnt confirm menopause

Question 9

what contraceptives can cause raised LH and FSH when stopped?

Answer 9

COC

depoprovera

Question 10

what antidepressants can cause increased LH and FSH?

Answer 10

SSRIs

Question 11

when should you check LH and FSH levels in suspected menopause?

Answer 11

hysterectomy patients

Question 12

presentation of menopause?

Answer 12

hot flushes
night sweats
palpitations
insomnia
joint aches
headaches

Question 13

average time for hot flushes during menopause is _ years

Answer 13

2

Question 14

duration of hot flushes?

Answer 14

3-5 minutes

Question 15

psychological symptoms of menopause?

Answer 15

mood swings
irritability
anxiety
difficulty concentrating
forgetfulness

Question 16

sexual symptoms of menopause?

Answer 16

vaginal dryness

libido

Question 17

why do women get sexual symptoms in menopause

Answer 17

ovaries produce testosterone and this increases libido; decreased collagen from less oestrogen causes vaginal dryness

Question 18

why do women get more urinary symptoms and UTIs?

Answer 18

collagen lines the bladder neck and is made by oestrogen

Question 19

later symptoms of menopause?

Answer 19

FUN symptoms 
dysuria
incontinence
dry hair/skin
atrophy of breast and genitals

Question 20

Ix perimenopausal dysfunctional uterine bleeding?

Answer 20

biopsy

Question 21

conservative Tx of menopause

Answer 21

diet - more plant oestrogens
weight loss 
exercise
lifestyle
remove caffeine

Question 22

Tx menorrhagia

Answer 22

1. mefenamic acid (NSAID) 
transexamic acid (anti-fibrinolytic)
2. progesterones (POP, implant, injection)
3. IUS
4. endometrial ablation
5. hysterectomy

Question 23

when should you take mefenamic and transexamic acid? what do they do?

Answer 23

only take with period, should reduce bleeding by half

Question 24

Tx vasomotor symptoms

Answer 24

HRT (1st line)
SSRIs
clonidine for hot flushes
lubricants

Question 25

why do you give both oestrogen and progesterone rather than just oestrogen?

Answer 25

if you continually proliferate the endometrium eg by just oestrogen it can increase endometrial cancer so give progesterone as a protector

Question 26

who can just take oestrogen as HRT?

Answer 26

hysterectomy patients

Question 27

HRT only increases risk of heart disease after _ years of taking it

Answer 27

10

Question 28

benefits of HRT?

Answer 28

symptom control
reduces osteoporotic risk
possibly protects against alzheimers/PD
reduced bowel cancer

Question 29

risks of HRT?

Answer 29

VTE
CVA
breast cancer
gallbladder disease

Question 30

clonidine is effective for what menopausal symptoms?

Answer 30

hot flushes