Menopause

Question 1

What is the definition of menopause?

Answer 1

Onset of the menopause is heralded by the cessation of menses for at least 12 consecutive months, without some other reason for amenorrhoea

Question 2

What is classed as early menopause?

Answer 2

Under 40 years old

Question 3

What are the symptoms of menopause?

Answer 3

Amenorrhoea
Irregular menstrual cycle
Hot flushes and night sweats
Vaginal symptoms
Mood changes
Other diagnostic factors
Sleep disturbance
Mild memory impairment
Menorrhagia

Question 4

What investigations should be done for menopause?

Answer 4

Pregnancy test
Serum FSH (raised)
Serum estradiol (reduced)

Question 5

What HRT should be given to women who have a uterus and are experiencing menopause with symptoms?

Answer 5

Combined regime of oestrogen and progesterone

Question 6

What contraindications are there for HRT?

Answer 6

Current Hormone dependent cancer breast/endometrium
Current active liver disease
Uninvestigated abnormal bleeding
Seek advice if previous VTE, thrombophilia
Seek advice if previous breast cancer or BRCA carrier

Question 7

What are the benefits of combined HRT?

Answer 7

Protects against vasomotor symptoms, local genital symptoms and osteoporosis
Protects against endometrial hyperplasia and cancer

Question 8

What are the risks of HRT?

Answer 8

Breast Cancer
Ovarian Cancer
Venous Thrombosis
CVA

Question 9

What other conditions should be considered in a woman who presents with menopausal symptoms?

Answer 9

Thyroid conditions
Lymphoma
Tuberculosis

Question 10

What should vasomotor symptoms be treated with?

Answer 10

Oestrogen

Question 11

When is progestogen needed in menopause?

Answer 11

If the woman still has a uterus

Question 12

What is andropause?

Answer 12

A slow drop in testosterone levels after the age of 30 but with no effect on fertility. Can lead to symptoms such as mood swings and irritability, loss of muscle mass and reduced ability to exercise, fat redistribution, such as developing a large belly or gynaecomastia,
a general lack of enthusiasm or energy, difficulty sleeping or increased tiredness and poor concentration and short-term memory

Question 13

What is the difference between primary and secondary amenorrhoea?

Answer 13

Primary amenorrhoea is a female who has never had a period
>14yrs and no secondary sexual characteristics
>16 years if secondary sexual characteristics
Secondary amenorrhoea is a female who has had periods in the past but none for 6 months

Question 14

What are some causes of secondary amenorrhoea?

Answer 14

Pregnancy / Breast feeding
Contraception related
Polycystic ovaries
Early menopause
Thyroid disease/ Cushings/ Any significant illness
Raised prolactin- prolactinoma/ medication related
Hypothalamic- stress/exercise
Androgen secreting tumour- testosterone >5mg/l
Sheehans syndrome- pituitary failure
Ashermans syndrome- intrauterine adhesions