menopause

Question 1

what is menopause?

Answer 1

when women havent had a period for a whole year

Question 2

why has there been an increase in the age at which you reach menopause?

Answer 2

bc of an increase in life expectancy

Question 3

what is the average age of menopause?

Answer 3

51-52 years

Question 4

when does early menopause occur?

Answer 4

20% of women aged 40-45 years

Question 5

when does premature menopause occur?

Answer 5

1% of women <40 years

Question 6

what is climacteric?

Answer 6

time leading up to and around the menopause (perimenopause)

Transitional phase where reproductive function declines and ceases

Question 7

what are symptoms of climacteric?

Answer 7

Changes in length of menstrual cycle

Hot flushes and night sweats

If menopause at 50 years, climacteric begins a year earlier

If menopause <40 years, climacteric begins 4 years earlier

Question 8

what are the short term symptoms of the menopause?

Answer 8

• Vasomotor = hot flushes, night sweats, headaches, palpitations
• Psychological =depression, mood swings, insomnia, memory loss and panic.
• Urogenital = urinary frequency, dysuria, stress and urge incontinence, vaginal dryness.
• Collagen = dry inelastic skin, brittle nails, hair loss, joint/muscle pains

Question 9

what are the long term consequences of menopause?

Answer 9

• CVS = ischaemic heart disease, hyperlipidemia
• Skeletal = osteopenia and osteoporosis
• Skin = inelastic, thin flaky skin, easy bruising
• Genito-urinary = more likely to get prolapse, incontinence.
• Physiological = Alzheimer’s disease

Question 10

what is second degree utero-vaginal prolapse?

Answer 10

uterus presses down near vaginal opening

makes it more difficult to do exercise

Question 11

what is procidentia?

Answer 11

uterus pressing in the vaginal opening

Question 12

how does Alzheimer’s affect the brain?

Answer 12

loss of density of white matter

Question 13

what is the pathophysiology of osteoperosis?

Answer 13

Resorption > osteogenesis –> reduction in bone mass

decreased bone density = easier fractures

Question 14

what ethnicity is osteoperosis most and least common in?

Answer 14

Commonest in white women and lowest risk in Afro-Carribeans

Question 15

how does osteoperosis present?

Answer 15

Changes in posture (walking) –> Dowager’s Hump: loss of bone density in vertebrae

easier fractures = decreased bone density

Question 16

how is menopause diagnosed?

Answer 16

• Triad of Diagnostic Features = typical symptomatology, blood tests (FSH increases after menopause: as oestrogen levels go down, FSH tries to stimulate the ovaries more) and 12 months’ amenorrhoea
• Serum Oestradiol Levels = only useful <45 as wide range of normality.
• Bone Mineral Densitometry = helps in the diagnosis of osteoporosis

Question 17

how is menopause treated?

Answer 17

hormone replacement therapy

Question 18

if the uterus is present, how is menopause treated and why?

Answer 18

oestrogen and progesterone

High level of oestrogen will hyper stimulate endometrium of uterus if progesterone not given (causes endometrial atrophy). This can lead to endometrial cancer.

Question 19

how is menopause treated if the uterus isnt present and why?

Answer 19

oestrogen

Because no hyper stimulation of endometrium so progesterone not necessary.

Question 20

what are the routes of administration of HRT?

Answer 20

oral, patches and gels, implants and injections, intravaginal creams, nasal sprays.

Question 21

what are common side effects of HRT?

Answer 21

• Heave cyclical/unscheduled irregular bleeding (oestrogen stimulates endometrium)
• Bloating, fluid retention and weight gain (associated with progesterone)
• Mastalgia (sore breasts)
• Headaches, muscle cramps and abdominal pain.
• Depression may occur in some women

Question 22

what are complications of HRT?

Answer 22

• Breast cancer (risk increases if you have more than 5 years of use)
• Thrombo-embolic events
o Deep vein thrombosis may cause stroke.
• Oestrogen alone may lead to endometrial cancer, but endometrial protection is given.

Question 23

what are contraindications of HRT?

Answer 23

• Breast cancer
• Endometrial Cancer
• TED (thyroid eye disease).
• Endometriosis
• Fibroids
• IHD (ischemic heart disease)

Question 24

what are non-hormonal treatments of HRT?

Answer 24

• Bisphosphonates and calcitonin
• Selective estrogen receptor modulators
o Stimulate increased oestrogen secretion.
• Clonidine and venlafaxine