Menopause

Question 1

what is the definition of menopause

Answer 1

• this is a year after the women had her last menstrual periods

Question 2

how many people does menopause occur in

Answer 2

12 million

Question 3

what is the average age of menopause

Answer 3

52 - in markscheue

(51.4) or 51-52

Question 4

what is the life expectancy of a women

Answer 4

82

Question 5

what is the early menopause

Answer 5

20% of women aged 40-45yrs

Question 6

what is premature menopause

Answer 6

1% of women lower than the age of 40

Question 7

what is perimenopause/ climacteric

Answer 7

this is the time leading up to and around the menopause

- it is the transitional phase during which reproductive function decline and ceases

Question 8

if menopause occurs around the age of 50 than the perimenopause can last for..

Answer 8

1-3 years

Question 9

what are the climacteric symptoms

Answer 9

Changes in length of menstrual cycle

Hot flushes / night sweats

If menopause at 50 yrs, climacteric begins a year earlier

If menopause less than or equal to 40 yrs, climacteric begins 4 years earlier

Question 10

what are the symptoms of menopause due to

Answer 10

• an decrease in oestrogen this is mainly due to the ovarian reserve being depleted

Question 11

what are the types of symptoms experienced in menopause

Answer 11

• short term symptoms

- long term symptoms

Question 12

Name the short term symptoms that occur

Answer 12

• vasomotor
• psychological
• urogenital
• collagen

Question 13

describe the short term symptoms that occur

Answer 13

Vasomotor - hot flushes and night sweats, headaches, palpitations

Psychological - depression, mood swings, insomnia, memory loss, panic

Urogenital urinary frequency, dysuria, stress & urge incontinence, vaginal dryness, dyspareunia (pain with sex)

Collagen - dry inelastic skin, brittle nails, hair loss, joint/muscle pain

Question 14

what is the most frequent short term symptom

Answer 14

• vasomotor symptoms

- these are mainly related to oestrogen

Question 15

in how many women do psychological symptoms occur in

Answer 15

occurs in 50% of women

Question 16

what are the long term consequences of menopause

Answer 16

CVS
Skeletal 
skin 
genito-urinary 
psychological

Question 17

describe the long term consequences of the symptoms of menopause

Answer 17

CVS - hyperlipidemia, ischaemic heart disease

Skeletal - osteopenia & osteoporosis

Skin - inelastic thin flaky skin, easy bruising

Genito-urinary – atrophic changes, prolapse, incontinence,
depressed libido & dyspareunia

Psychological - Alzheimer’s Disease

Question 18

how is oeseoporosis pathophysiological caused in women with menopause

Answer 18

• In the bones there is a balance between reabsorption and oestogensis in menopause resorption increases by oesotgensis decreases thus there is a reduction in bone mass

Question 19

what women is otesoporsis common in

Answer 19

Common in white women
- (50% have 1 fracture by 82 years)

Lowest risk in Afro-Carribeans

Question 20

what happens to the uterus during menopause

Answer 20

can prolapse

• there can be utero-vaginal prolapse - this is when the uterus is 2nd degree as it does not go through the vagina
• there can be 3rd degree prolapse this is when it goes completely through the vagina

Question 21

how can you diagnose menopause

Answer 21

• triad of diagnostic features include - typical symptomatology, 12 months amenorrhoea, FSH greater than 15 iu/ml
• serum estradiol levels (decreases) - these are only useful at the age of less than 45 years, these

Bone mineral densitometry (this decreases as well)
- this is helpful int he diagnosis of osetoprosis

Question 22

what are the 2 treatments for menopause

Answer 22

• hormone replacement therapy (HRT)

- non-hormonal treatments

Question 23

what are the two types of HRT

Answer 23

if uterus present :
oestrogen + progesterone

If uterus absent :
oestrogen alone

Question 24

why do you give oestrogen and progesterone as a hormone related therapy if you have a uterus

Answer 24

-If you only give oesrogen – lining will become thick and lead to metaplasia therefore you need to give progesterone at the same time

Question 25

what are the routes of administration for HRT

Answer 25

Oral
Patches and gels
Implants & Injections – 6 months 
Intravaginal creams, pessaries, rings
Nasal sprays

Question 26

what is the problem with oral absorption

Answer 26

• it is not very stable but it may help for a little bit

Question 27

how often do you change the HRT transdermal patches

Answer 27

change them twice a week

Question 28

what are the gels and creams that can be used

Answer 28

oestrogel
- Gel rub on arm and leg
2 lines per day
- If more symptoms they can go up to 3 or go down to 1 line
- If they have a uterus you need to give progesterone

Question 29

what are the common side effects of HRT

Answer 29

Heavy cyclical / Unscheduled irregular bleeding

Bloating, fluid retention and weight gain

Mastalgia – pain on the breast

Headaches, Muscle cramps, Abdominal pain

Depression

Question 30

what are the serious complications of HRT

Answer 30

Breast cancer - risk increases >5yrs of use, by approx 2-6/1000 women

Thrombo-embolic events
- DVT / PE affect approx 5/10,000 women on HRT, and most commonly occur in
the first year of use

Question 31

what are some non-hormonal treatments

Answer 31

Biphosphonates & Calcitonin : Decrease osteoclast activity

Selective estrogen receptor modulators (SERM)

Clonidine & Venlaflaxine : Reduce vasomotor symptoms

Question 32

what are the lifestyle issues with menopause

Answer 32

Vitamins

Herbs

Phyto-oestrogens

Exercise

No smoking