Menopause

Question 1

What is menopause?

Answer 1

part of the natural ageing process where menstruation stops - woman no longer able to reproduce

Question 2

When can menopause be diagnosed?

Answer 2

permanent cessation of menstruation fro 12 motnhs

Question 3

Why does menopause occur?

Answer 3

when there are no primary follicles let so the ovaries are no longer to produce follicles and oestrogen levels start to decline

Question 4

What is the difference between physiological and pathological menopause?

Answer 4

physiological - normal (happens between 45-55)

pathological - abrupt cessation before 40 yrs

Question 5

What are the stages of menopause?

Answer 5

pre-menopause, peri-menopause, menopause, post-menopause

Question 6

What is pre-menopaurse?

Answer 6

this describes the initial changes that occur to a menstrural cycle - shortening, problems with fertility can occur because ovulation is early or absent

Question 7

What is the hormonal effects of pre-menopause?

Answer 7

oestrogen levels fall –> negative feedback on the HPG axis is removed and levels of LH and FSH rise

Question 8

Why does FSH rise more than LH?

Answer 8

because of the removal of inhibin on the HPG axis

Question 9

What is peri-menopause?

Answer 9

also known as the transition phase - where aditional physiological changes occur - mood swings and hot flushes - greater infrequency of menstruation (follicular phases shortens)

Question 10

What is menopause?

Answer 10

Permanent cessation of menstruation caused by ovarian follicular development failure

Question 11

What is post-menopause?

Answer 11

A woman who has experienced the changes

Question 12

When is pregnancy not possible?

Answer 12

only after all the follicles are gone (can still get pregnant in pre and peri menopause

Question 13

Which hormone is measured to diagnose physiological menopause?

Answer 13

FSH (also LH and oestrogen) but FSH is the diagnostic test

Question 14

What are the 7 symptoms of menopause?

Answer 14

Itchy, twitchy, sweaty, sleeping, bloated, moody, forgetful

Question 15

What are the consequences of oestrogen deficiency?

Answer 15

Look at slide 17/18 on menopause lecture

Question 16

What are the early symptoms of menopause?

Answer 16

hot flushes and sweating, insomnia and depression

Question 17

Why do some women get hot flushes?

Answer 17

due to decrease in oestrogen (as a treatment is to give oestrogen and progesterone) - causes vascular changes (vasodilation) - you get a noticeable rise in temperature

Question 18

Why does dysfunctional uterine bleeding occur and why does it need to be investigated?

Answer 18

Changes in oestrogen concentration that causes the endometrium to keep ticketing leading to a late menstrual period and irregularity/spotting - no corpus xeutrum means no progesterone so you are at risk of endometrial carcinoma as unopposed oestrogen

Question 19

What are the psychological changes in menopause?

Answer 19

-headache, irritability, fatigue, depression

Question 20

Why do these psychological changes occur?

Answer 20

most likely due to lack of sleep because of the night sweats - less likely to be due to hormone changes

Question 21

What are the intermediate stages of menopause?

Answer 21

further to decreasing levels of oestrogen - vaginal atrophy leading to dyspareunia (from vaginal dryness) and can cause increased risk of UTI and stress incontinence

Question 22

Why do the ovaries become smaller?

Answer 22

oestrogen production decreases so ovarian atrophy

Question 23

What other changes occur to the external genitalia?

Answer 23

reduction in pubic hair due to reduced testosterone

Question 24

What causes changes in general appearance and what are they?

Answer 24

Skin - looses elasticity becoming thin and fine - due to loss of elastin and collagen
Weight - increases are more likely to indulge in irregular food because of mood swings - distribution it to hips waist and buttocks
Hair - fine, course and dry - hair loss due to oestrogen falling
Voice - deeper due to thickening of vocal cords

Question 25

Why do menopausal woman get more constipation?

Answer 25

reduced motor activity of the GI getting bloating - oestrogen also prompts tone in smooth muscle so low oestrogen means lack of tone - constipation due to sluggish intesting

Question 26

Why do you get urinary symptoms and what are they?

Answer 26

Due to low oestrogen, the tissue lining the urethra and bladder become drier, thinner and less elastic

• loss of pelvic tone
• urinary incontinence
• increased frequency and UTI’s

Question 27

What does the decreased oestrogen do to bone?

Answer 27

enhances osteoclast activity so increases bone reabsoprtion so more calcium is lost from bone - results in osteoporosis - main reasons for fractures in older age
-also reduced bone mass - can lead to shortening of height

Question 28

What affects does falling oestrogen levels have on CVS?

Answer 28

low levels of oestrogen and progesterone cause changes in lipid profile in post menopausal women - increasing circulating lipid levels increase risk of atherosclerosis and embolic effects (MI and stroke)

Question 29

What is the management of menopause?

Answer 29

may need supportive treatment - can be non-hormonal or hormonal

Question 30

What non-hormonal treatment is offered to menopausal women?

Answer 30

• dressing in light layer (hot flushes)
• avoid caffeine alcohol and spicy foods
• lifestyle changs (exercise/healthy eating)

Question 31

What hormonal treatment is offered to menopausal women?

Answer 31

HRT - orally in pill form, vaginally (cream) or transdermally (patches)

Question 32

How does HRT work?

Answer 32

replaces female hormones produced by the ovaries

Question 33

What are some benefits or risks of HRT?

Answer 33

benefits - can limit osteoporosis

risks - ovarian cancer

Question 34

NOTE

Answer 34

if woman has had hysterectomy - can just have oestrogen - if not needs oestrogen and progesterone as unopposed oestrogen is dangerous