Menopause

Question 1

Define menopause

Answer 1

The last menstrual period a woman has

retrospective diagnosis

Question 2

What is early menopause?

Answer 2

aged <45

Question 3

What is premature menopause?

Answer 3

aged <40

Question 4

What is late menopause?

Answer 4

aged >54

Question 5

What is peri-menopause?

Answer 5

the transition from pre-menopausal to post menopausal

and is the time where symptoms are experienced

Question 6

What role does GnRH play in the physiology of menopause?

Answer 6

GnRH stimulates release of FSH and LH

Question 7

What are the changes in hormone levels in menopause?

Answer 7

increased FSH and LH (with FSH being more pronounced)

change in the balance of oestrogen (lowered E2, proportionally increased E1)

Question 8

What form of oestrogen is produced by the ovaries and how is this done?

Answer 8

E2 (estradiol)
FSH and LH stimulate the follicular cells within the ovary - theca cells to produce androstenedione which the granulosa cells use to produce estradiol.

Question 9

What hormones are produced by granulosa cells?

Answer 9

Oestrogen

Progesterone

Question 10

Less circulating oestrogen causes what?

Answer 10

reduced proliferation of the endometrium

Question 11

Why are overweight women more at risk of endometrial cancer?

Answer 11

The adipose tissue produces oestrogen (E1) which stimulates uncontrolled endometrial growth

Question 12

List the symptoms of menopause

Answer 12

night sweats
palpitations 
fatigue, insomnia
joint pain (arthralgia)
dizziness/headache 
reduced libido 
hot flushes 
low mood, anxiety
irritability, reduced concentration, forgetfulness
dry skin
thinner har 
loosening of the pelvic floor (prolapse)
urinary: frequency, nocturne, incontinence, recurrent UTI

Question 13

What are the long term effects of menopause?

Answer 13

osteoporosis

increased risk of CVD and CVA

Question 14

How is the diagnosis of menopause made?

Answer 14

Clinically after 1 year of amenorrhoea

if early: investigate FSH levels >430, 2 readings (6 weeks apart)

Question 15

When can FSH levels be raised, other than with menopause?

Answer 15

When ovulating
Breastfeeding
just stopped COCP or depoprovera
on SSRI medication

Question 16

How do we manage menopause with lifestyle factors?

Answer 16

weight loss
smoking cessation
complimentary therapies

Question 17

How do we manage menopause?

Answer 17

Lifestyle factors
HRT
Vaginal dryness: topical oestrogen (regelle, Yes, silk) - vaginal lubricants
condone - for menopausal flushing

Question 18

How can HRT be administered?

Answer 18

orally, transdermal patch

injection , mirena coil, intravaginally (pessary ring)

Question 19

What are the different types of HRT?

Answer 19

Oestrogen only
Combined - oestrogen/progesterone
(sequential method/continuous)

Question 20

Who can use oestrogen only HRT?

Answer 20

women without a uterus

as unopposed oestrogen is a risk factor for endometrial cancer

Question 21

Who can use combined HRT?

Answer 21

Any women with a uterus

if still needing contraception - use combined HRT plus the mirena coil as HRT alone is insufficient

Question 22

Describe the sequential regimen of HRT

Answer 22

oestrogen for 28 days
progesterone for the 2nd half of the cycle
mimics the natural process

can only use it for 2 years

Question 23

Describe continuous HRT and who can use it

Answer 23

those post menopausal (LMP >1 year ago) or who have used sequential HRT for 2 years

there will be no period after 6 months of Tx

Question 24

What are the benefits of HRT?

Answer 24

Reduced symptoms
reduces risk of colorectal cancer
prevention of osteoporosis

Question 25

What are the risks of HRT?

Answer 25

VTE
Stroke
Cancer (endometrial, ovarian, breast
?dementia/CVD

Question 26

Name a contraindication to HRT?

Answer 26

Angina