Menopause

Question 1

What is the menopause and why is it usually a retrospective diagnosis?

Answer 1

Last ever menstrual period

- retrospective as is only usually diagnosed after a year of amenorrhoea

Question 2

What is the average age of menopause in the UK?

Answer 2

51

Question 3

What ages would be considered an early or premature menopause?

Answer 3

Early menopause <45yrs

Premature menopause <40yrs

Question 4

What age is considered a late menopause?

Answer 4

Late menopause >54yrs

Question 5

Why do periods stop?

Answer 5

• need ovulation for periods to occur
• women are born with around 1 million eggs, but these are all lost by the age of 50
  => if no ovulation is occurring the woman cannot bleed

Question 6

What effects of oestrogen are essentially “reversed” in the menopause?

Answer 6

• Secondary sexual characteristics
• Hair distribution, body shape + fat distribution
• Effect on collagen
• Bone growth
• Proliferates endometrium

Question 7

HOw is the menopause diagnoseD?

Answer 7

Vasomotor Symptoms
Pattern of periods
Blood tests? (sometimes)

Question 8

What vasomotor symptoms do women often find the most debilitating?

Answer 8

• Hot flushes
• last for 3-5 mins
• severe in around 20%

Question 9

Why must multiple blood tests be taken to diagnose the menopause?

Answer 9

• one single raised FSH/LH doesnt confirm
• Normal FSH/LH doesnt exclude
• Usually 2 blood tests 6 weeks apart

Question 10

Why else may FSH levels be raised on a menopausal blood test?

Answer 10

• prior to ovulation
• Combined oral contraceptive OR Injection
• Breastfeeding
• Effect of certain medication (e.g. SSRI)

Question 11

Why may a patient with a hysterectomy be more difficult to diagnose with menopause?

Answer 11

• No abnormal bleeding pattern seen

Question 12

Women who are happier in life experience less menopausal symptoms. TRUE/FALSE?

Answer 12

TRUE

Question 13

What psychological symptoms can occur during menopause?

Answer 13

Mood swings
Irritability
Anxiety
Forgetfulness
Difficulty Concentrating

Question 14

What other physical symptoms are common in menopause?

Answer 14

Night sweats
Palpitations
Insomnia
Joint aches
Headaches

Question 15

What sexual symptoms are experienced by women in the menopause?

Answer 15

Vaginal dryness

Libido

Question 16

What symptoms of the menopause usually appear later than others?

Answer 16

Urinary

• Frequency
• Recurrent UTIs
• Dysuria
• Incontinence
• Skin and hair changes
• Atrophy of breast and genitals

Question 17

What are the different types of perimenopausal dysfunctional uterine bleeding?

Answer 17

Irregular periods
Inter-menstrual bleeding (between periods)
Post menopausal bleeding

Question 18

If a woman experiences post-menopausal bleeding, what diagnosis do you want to rule out first?

Answer 18

Endometrial cancer

Question 19

What conservative management can be used in the menopause?

Answer 19

• Diet/Weight loss/Exercise
• Reduce caffeine
• CBT/Mindfulness for hot flushes/mood swings

Question 20

What treatments can be used for menorrhagia?

Answer 20

• Mefenamic acid (NSAID - decreases blood to uterus)
• Tranexamic acid (antifibrinolytic - stops clot breakdown)
• Progesterones
• Intra-uterine system(IUS) - used for HRT, contraception, protection against endometrial cancer
• Endometrial ablation
• Hysterectomy

Question 21

If oestrogen only HRT is given, this can increase a woman’s risk of endometrial cancer. TRUE/FALSE?

Answer 21

TRUE

Question 22

How can HRT be given?

Answer 22

• Patch
• Oral
• Oestrogen only (+ mirena coil to prevent cancer)
• Combined

Question 23

What are the contra-indications for HRT?

Answer 23

Breast cancer
Abnormal vaginal bleeding
Endometrial cancer
Pregnancy
Active thrombo-embolic disorder
Recent MI
Active liver disease with abnormal LFT
Porphyria cutanea tarda

Question 24

Why is HRT given after a subtotal hysterectomy?

Answer 24

• cervix is left in during this procedure
  => small bits of endometrium may also be left
• certain types of HRT will cause this to bleed and show there is tissue left

Question 25

What Non-HRT methods are used to control symptoms of menopause?

Answer 25

• Clonidine (antihypertensive with temperature regulation => useful if HRT contraindicated)
• SSRIs

Vaginal Lubricants:

• Regelle
• Yes
• Sylk