Menopause

Question 1

What is menopause?

Answer 1

A woman’s last ever menstrual period

Question 2

What is the climacteric period?

Answer 2

Time leading up to menopause when symptoms appear

Question 3

What is average age for menopause to occur?

Answer 3

51 years old

Question 4

When is menopause considered premature?

Answer 4

If it occurs before the age of 40

Question 5

When is menopause considered late?

Answer 5

If it occurs after the age of 54

Question 6

When is menopause considered early?

Answer 6

If it occurs before the age of 45

Question 7

Absence of what hormone causes the menopause?

Answer 7

Oestrogens

Question 8

What cells secrete oestrogen?

Answer 8

Granulosa cells

Question 9

Which sex harmones control the release of oestrogen?

Answer 9

FSH and LH from the anterior pituitary

Question 10

State the physiological effects of oestrogen on the body

Answer 10

Secondary sexual characteristics
Hair distribution
Body shape
Fat distribution
Prevents reduction in collagen
Bone growth

Question 11

What effect does oestrogen have on the endometrium?

Answer 11

Proliferates and thickens the endometrium

Question 12

List diagnostic options for menopause

Answer 12

Symptoms
Pattern of periods
Blood tests in women under 45yo or hysterectomy

Question 13

How are blood tests used to diagnose menopause?

Answer 13

FSH and LH levels taken twice two weeks apart

Question 14

What happens to FSH and LH levels following menopause?

Answer 14

They increase as there is no oestrogen to negatively feedback to inhibit release

Question 15

List some physical symptoms of menopause

Answer 15

Hot flushes (very common)
Night sweats
Palpitations
Insomnia
Joint aches
Headaches

Question 16

List some psychological symptoms of menopause

Answer 16

Mood swings
Irritability
Anxiety
Difficulty concentrating
Forgetfulness

Question 17

List some sexual symptoms of menopause

Answer 17

Vaginal dryness

Libido loss

Question 18

List some late-on features of menopause

Answer 18

Frequency
Recurrent UTIs
Dysuria
Incontinence
Dry hair and skin
Atrophy of breasts and genitals

Question 19

State the types of perimenopausal dysfunctional uterine bleeding

Answer 19

Irregular periods
Intramenstrual bleeding
Post-menopausal bleeding

Question 20

Why does perimenopausal bleeding occur?

Answer 20

Excess unopposed oestrogen without enough progesterone (no ovulation)

Question 21

List common causes of post-menopausal bleeding

Answer 21

Atrophic vaginitis
Cervical polyps
Endometrial hyperplasia
Endometrial cancer

Question 22

When is bleeding following menopause considered post-menopausal bleeding?

Answer 22

After 1 year of having menopause

Question 23

Outline conservative management options for menopause

Answer 23

Diet (soy)
Weight loss
Exercise
Lifestyle
Caffeine 
Alcohol

Question 24

Which NSAID can be given for post-menopausal bleeding? How does it help?

Answer 24

Mefenamic acid

Reduces blood supply to uterus to minimise bleeding

Question 25

Which antifibrinolytic can be given for post-menopausal bleeding? How does it help?

Answer 25

Tranexamic acid | Delays clot breakdown

Question 26

Why could progesterone agents be given for post-menopausal bleeding?

Answer 26

Stabilise womb lining and make it less likely to proliferate

Question 27

What treatment offers endometrial protection for up to 4 years against menorrhagia?

Answer 27

Intra-uterine system (releases low-dose progesterone)

Question 28

List management options for menorrhagia

Answer 28

``` Mefenamic acid Tranexamic acid Progesterone Intra-uterine system Endometrial ablation Hysterectomy ```

Question 29

What symptoms does HRT help treat?

Answer 29

Vasomotor symptoms (hot flushes/night sweats). Mood swings. Vaginal and bladder symptoms

Question 30

Which harmones are typically given in HRT? Which routes of administration can be used?

Answer 30

Progesterone and oestrogen | Topical, oral

Question 31

List some benefits of HRT

Answer 31

``` Symptom control Reduces risk of osteoporotic fracture Reduces risk of bowel cancer Possibly protective against AD and PD Possibly less cardiovascular events ```

Question 32

List some risks of HRT

Answer 32

VTE CVA Breast cancer Gallbladder disease

Question 33

In what situations, should HRT be avoided?

Answer 33

Patient is at risk of breast cancer | Patient is at risk of VTE

Question 34

Which antihypertensive can be used for management of menopause?

Answer 34

Clonidine

Question 35

Which class of antidepressants can be used for management of menopause?

Answer 35

`SSRIs

Question 36

Which moisturisers or lubricants can be used for management of menopause?

Answer 36

Regelle Yes Sylk

Question 37

State an absolute contraindication to HRT

Answer 37

Active or recent arterial thromboembolic disease

Question 38

In woman with a uterus or with a partial hysterectomy offer...

Answer 38

Combined (oestradiol plus progestogen) HRT preparation

Question 39

In women with a full hysterectomy offer...

Answer 39

Oestrogen-only preparation

Question 40

In women diagnosed with premature menopause offer...

Answer 40

Sex steroid replacement with a choice of HRT or a combined oral contraceptive (unless contraindicated, for example in women with hormone-sensitive cancer)