Menopause

Question 1

What are the relevant ages to menopause?

Answer 1

• average age of menopause: 51
• early menopause <45
• premature menopause <40
• late menopause >54

Question 2

What are the causes of early menopause?

Answer 2

• oopherectomy
• chemotherapy
• genetics (Turner’s syndrome)
• autoimmune disorders

Question 3

What is required to make a diagnosis of menopause

Answer 3

• bleeding patterns (irregular/absent menstruation)
• symptoms (hot flushes, mood swings etc)
• blood tests (not accurate)

Question 4

Why are blood tests not an accurate measure of menopause?

Answer 4

• pulsatile release of FSH and LH
• single raised level of gonadotropins does not indicate menopause
• raised prior to ovulation
• raised in response to stopping CHC and depo provera
• rasied with breastfeeding and some medication (SSRI)

Question 5

What are the physical symptoms of menopause?

Answer 5

• hot flushes
• night sweats
• palpitation
• insomnia
• joint aches
• headaches

Question 6

What are the psychological symptoms of menopause?

Answer 6

• mood swings
• poor concentration
• irritability
• forgetfulness
• anxiety

Question 7

what are the sexual symptoms of menopause?

Answer 7

• vaginal dryness (due to reduced oestrogen)

- decreased libido (testosterone is produced in small amounts in the ovary which is responsible for libido)

Question 8

What are the symptoms that may appear later on in menopause?

Answer 8

• increased urinary frequency (weaker bladder neck)
• recurrent UTI
• dysuria
• incontinence (vaginal atrophy causes OAB)
• dry hair and skin
• genital and breast atrophy

Question 9

What conservative management steps can be done?

Answer 9

• weight loss
• exercise
• diet (soy products may help relieve symptoms of menopause)
• reduce caffeine intake

Question 10

What can be done to manage menorrhagia?

Answer 10

-mefenamic acid: NSAID that reduces blood supply to the endometrium by reducing prostaglandin production and binding of prostaglandin E2 (only take during period)
Tranexamic acid-antifibrinolytic which prevents formation of blood clots
-progesterone (POP, depo provera)
-IUS
-Endometrial ablation
-hysterectomy

Question 11

What types of HRT may be used in menopause?

Answer 11

• oestrogen only (if pt has mirena coil and has undergone hysterectomy)
• oestrogen and progesteron (topical/oral)

Question 12

What non-HRT treatments are available?

Answer 12

• clonidine-alpha 2 agonist
• SSRI
• Regelle (vaginal moisturiser)
• Yes (vaginal moisturiser)
• sylk (vaginal lubricant)