menopause

Question 1

what is menopause?

Answer 1

Cessation of menstruation
Average age 51 years
Diagnosed after 12 months of amenorrhoea
Onset of symptoms if hysterectomy

Question 2

What is perimenopause?

Answer 2

Period leading up to the menopause

Characterised by irregular periods and symptoms eg hot flushes, mood swings, urogenital atrophy

Question 3

What are the vasomotor symptoms of menopause?

Answer 3

hot flushes and sweats

Question 4

what are musculoskeletal symptoms of menopause?

Answer 4

joint and muscle pain

Question 5

what effect does menopause have on the vagina?

Answer 5

dryness and vaginal atrophy

Question 6

short term impact of menopause?

Answer 6

vasomotor symptoms (hot flushes and sweats)

generalised symptons: mood changes, loss of memory, headaches

Question 7

medium term impact of menopause?

Answer 7

urogenital atrophy
dyspareunia
UTIs
PMB
incontinence and prolapse

Question 8

long term impact of menopause?

Answer 8

osteoporosis-reversible with oestrogen

cardiovascular disease

dementia

Question 9

management of menopause?

Answer 9

lifestyle
reduce modifiable risk

HRT
Clonidine (non hormonal)
CBT

Question 10

Benifits of HRT in menopause?

Answer 10

relief of menopause symptons

bone protection

Question 11

side effects of HRT?

Answer 11

beast cancer
VTE (venouse thrombo embolism)
Cardiovascular disease

Question 12

are the risks of HFT increased if oesterogen is combined with progesteron?

Answer 12

HRT with oestrogen alone – little or no change in risk

HRT with oestrogen + progesterone – increased risk

Increased risk is related to treatment duration and reduces after stopping HRT

Question 13

when not to use HRT?

Answer 13

in women with breast cancer

Question 14

VTE and HRT use?

Answer 14

Oral > Transdermal
(same for the risk of stroke too)

Transdermal = baseline population
Transdermal – BMI >30 or increased risk of VTE

Question 15

cardiovascular disease and HRT?

Answer 15

HRT does not increase cardiovascular risk when started in women < 60 years

The presence of cardiovascular risk factors is not a CI to HRT as long as they are optimally managed

Question 16

Does HRT adverse affect diabetes?

Answer 16

Oral or TD does not increase

HRT is not generally associated with an adverse effect on BG control

Question 17

should progesteron be used in HRT>

Answer 17

Progesterone should be used for at 12-14 days every 4 weeks - sequential

Protects the endometrial from the stimulatory effects of unopposed Estrogen

Question 18

who should have transdermal HRT?

Answer 18

Gastric upset eg Crohns

Need for steady absorption eg migraine/epilepsy

Perceived increased risk of VTE

Older women ‘higher risk of HRT’

Medical conditions eg hypertension
Patient choice

Question 19

what is premature ovarian insufficiency?

Answer 19

menopause <40yrs
natural or latrogenic (sugery, chemo/radio)
primary or secondary

majority of cases are idiopathic

Question 20

what is the diagnosis test for premature ovarian insufficiency?

Answer 20

FSH >25IU/l – 2 samples >4 weeks apart + 4 months of amenorrhoea

Question 21

premature ovarian insufficiency and HRT?

Answer 21

women with premature ovarian insufficiency are encouraged to use HRT at least until the average age of the menopause.

Question 22

can you use HRT in over 60s?

Answer 22

no