Menopause

Question 1

Define menopause (2)

Answer 1

The permanent cessation (over 12 months) of menstruation that normally happens when a woman is 45-55 and marks the end of her fertility.

Question 2

Explain why menopause happens. (1)

Answer 2

There are no primary follicles left to be released, so oestrogen levels drop. This creates all the of the symptoms typical of menopause.

Question 3

Describe the first stage of menopause. (4)

Answer 3

Pre-menopausal - changes occurring in the cycle, like shortening and absent ovulation. Oestrogen and inhibin fall, so negative feedback on the HPG is gone, so FSH and LH rise.

Question 4

Describe the second stage of menopause. (3)

Answer 4

Peri-menopause - the “transition phase” where additional physiological changes occur which disrupt menstruation further like hot flushes and mood swings.

Question 5

Describe the third stage of menopause (1)

Answer 5

Actual menopause - cessation of periods for over 12 months.

Question 6

Describe the fourth stage of menopause. (1)

Answer 6

After those 12 months, when all of these have been experienced and things begin to settle.

Question 7

Explain why it is possible to become pregnant in the pre- or peri-menopausal states. (2)

Answer 7

There are still follicles that are being released monthly, it is just irregular and unusual.

Question 8

Describe symptoms of early menopause. (6)

Answer 8

Lowered levels of oestrogen leads to:
Hot flushes
Vasomotor
Insomnia
Mood swings
Depression
Irregular periods.

Question 9

Describe symptoms of intermediate stage menopause. (7)

Answer 9

Further decreasing oestrogen leads to:
Vaginal atrophy - dyspareuria
Urethral and bladder lining atrophy - UTIs, stress incontinence.
Ovarian, breast and uterine atrophy
Skin elasticity reduction
Bloating
Constipation
Initially high testosterone (in comparison to oestrogen levels) causes voice and hair changes
Eventually lowered testosterone leads to loss of pubic hair.

Question 10

Explain why late stage menopause can lead to increased cardiovascular or osteoporosis risk. (4)

Answer 10

Bone - reduction in oestrogen enhances osteoclast action so more bone is reabsorbed. Leads to osteoporosis and reduced height.
CVS - low levels of oestrogen and progesterone change the lipid profile in these women, which can increase risk of atherosclerosis and therefore MI and stroke.

Question 11

Describe the non-pharmacological managements of menopause. (2)

Answer 11

Lifestyle advice to help with vasomotr symptoms and dietary advice to reduce weight gain and reduce CVS risk.

Question 12

Describe the pharmacological managements of menopause. (2)

Answer 12

Hormonal treatments locally or systemically replacing oestrogen.
Bisphosphates to inhibit osteoclast action.

Question 13

Explain the advantages of HRT. (3)

Answer 13

Replace some of the lost oestrogen, so stops lots of the symptoms. Decreases osteoporosis, decreases the normal loss of muscle mass.

Question 14

Explain the disadvantages of HRT. (4)

Answer 14

Increases blood clots, increases stroke, increases breast cancer (if with progesterone), increased endometrial cancer (if oestrogen alone).

Question 15

Explain the idea of the seven dwarfs of menopause.

Answer 15

Itchy, twitchy, sweaty, sleepy, bloated, moody and forgetful.
Common symptoms indicative of menopause.