Menopause

Question 1

Symptoms of the menopause

Answer 1

• menstrual irregularity
• vasomotor disturbance e.g. sweats, palpitations, hot flushes
• atrophy of oestrogen-dependent tissues (genitalia, breasts) and skin
• urogenital symptoms (vaginal dryness leading to UTI, dysparyunia, traumatic bleeding, stress incontinence, prolapse)
• osteoporosis
• joint and muscle pain
• effects on mood
• sexual difficulties/low libido

Question 2

When to diagnose premature menopause

Answer 2

• women <40y
• with menstrual Sx including no/infrequent periods
• and elevated FSH levels on 2 blood samples taken 4-6wks apart

Question 3

Treatment of premature menopause

Answer 3

COCP/HRT (if not CI)

Question 4

When should FSH be measured?

Answer 4

• NOT routine for menopause
• women 40-45y with menopausal Sx including cycle change
• women <40y where menopause suspected

Question 5

When should contraception be used until in menopause?

Answer 5

> 50s: until 1y amenorrhoea

<50: until 2y amenorrhoea

Question 6

What type of HRT is indicated for different women

Answer 6

• no uterus: oestrogen-only
• uterus: combination HRT

Combination HRT:

• oestrogen + cyclical progesterone in women still having periods or within 12m of a period
• continuous combined HRT in post-menopausal women

Question 7

When can menopause be diagnosed?

Answer 7

amenorrhoea >1y

Question 8

CIs to HRT (7)

Answer 8

• oestrogen dependent cancer (endometrial, breast, bowel)
• previous PE/?DVT
• liver disease
• undiagnosed PV bleeding
• pregnancy
• breastfeeding
• phlebitis

Question 9

Annual check up on HRT

Answer 9

• breasts
• BP (stop if >160/100 and Ix)
• weight
• any abnormal bleeding?

Question 10

Alternative to HRT for vasomotor symptoms

Answer 10

SSRIs

Question 11

Risks of HRT

Answer 11

• breast cancer risk increased 2.3%/yr, risk dependent on duration, returns to normal 5y after stopping
• unopposed oestrogens: endometrial cancer (so not given if uterus)
• > 2x risk VTE (risk still small)
• increased risk gallbladder disease
• oral oestrogen: small increase in risk of stroke

Question 12

How can oestrogen be administered?

Answer 12

• orally
• transdermally (patch/gel)
• SC
• vaginally

Question 13

How can progesterones be administered?

Answer 13

• orally
• transdermally
• via IUS