Menopause

Question 1

Describe the hormonal changes which lead to the features of the menopause

Answer 1

Ovaries prod lower levels of oestrogen + progesterone

Question 2

Define menopause

Answer 2

No menstrual periods for 12 consecutive months and no other biological or physiological cause can be identified

Question 3

What is physiological menopause?

Answer 3

The normal decline in ovarian function due to ageing begins in most women between ages 45 and
55 on average 50

Question 4

What is pathological menopause (premature ovarian insufficiency)?

Answer 4

The gradual or abrupt cessation of menstruation before 40 years

Question 5

What is the pre-menopause phase?

Answer 5

Changes in menstrual cycle start to occur

Follicular phase shortens

Ovulation early or absent

Less oestrogen secreted = LH and FSH levels rise, FSH more (reduced negative feedback)

Reduced fertility

Question 6

Outline the peri menopause phase

Answer 6

End of reproduction capacity

Terminating with the completion of menopause

Question 7

Outline the menopause phase

Answer 7

Permeant cessation of menstruation caused by ovarian follicular devel failure

Question 8

Describe the post-menopausal phase

Answer 8

Time after which a women has experience 12 consecutive months of amenorrhea without a period

Question 9

Outline the cause of menopause

Answer 9

Ovaries are totally depleted of follicles = oestrogen levels fall dramatically = no -ve feedback = FSH and LH levels rise

Question 10

How is the menopause diagnosed?

Answer 10

No blood test >45y, symptoms only

FSH >40 2x 4-6w apart

Question 11

What are the consequences of oestrogen def?

Answer 11

Early = hot flushes, insomnia, menstrual irregularity

Intermediate = vaginal atrophy, skin atrophy, painful sex, urge-stress incontinence

Late = osteoporosis, atherosclerosis, Alzheimer’s disease

Question 12

How does the menopause effect the vasomotor system?

Answer 12

80% get transient increases in temp

Changes can = panic attacks, anxiety, insomnia

Cycle of increased temp varies

Question 13

How does the menopause effect uterine bleeding?

Answer 13

Spotting, heavy, mid-cycle, longer time between, longer/shorter periods

Question 14

What psychological changes are seen during menopause?

Answer 14

frequent headache

irritability

fatigue

depression and insomnia

Although these are often said to be due to changes in the hormonal levels, they are more likely to be related to the loss of sleep due to night sweat

Diminished interest in sex may be due to emotional upset or may be secondary to painful intercourse due to a dry vagina

Question 15

Outline the changes in the ovaries seen during menopause

Answer 15

Ovaries become smaller = oestrogen prod declined

For a while androgen prod still occurs – aromatase converts to oestrogen

Question 16

What changes are seen in general appearance during menopause?

Answer 16

Skin = loses elasticity

Weight = gain result of irregular food habits, more deposition of fat around hips, waist, buttocks

Hair = dry and coarse

Voice = deeper due to thickening of vocal cords

Question 17

How is the digestive/urinary system effected by the menopause?

Answer 17

D = motor activity diminished

U = tissue lining the urethra and the bladder become drier, thinner and less elastic

Question 18

How do the genital organs change due to the menopause?

Answer 18

Uterus = small and fibrotic due to atrophy of muscles

Cervix = smaller, appears to be flush with the vagina

Vulva = fat loss, sparse hair

Breast = flat and shrivelled

Question 19

How are the bones affected by menopause?

Answer 19

Increased osteoclast activity = increased risk of osteoporosis

Question 20

How does the menopause effect the CVS?

Answer 20

Total cholesterol increased

Triglycerides increase

BP increase

Carb tolerance decreases

Question 21

List the advantages of HRT in the post- menopausal woman

Answer 21

Can improve wellbeing

Most effective treatment for hot flushes and low mood

Can limit osteoporosis

Reduce vaginal dryness

Question 22

List the disadvantages of HRT in the post- menopausal woman

Answer 22

Increased risk of breast Ca, VTE, stoke, CVD

SE - headaches, breast tenderness, bloating, muscle cramps, irregular bleeds

Question 23

How is the menopause managed naturally?

Answer 23

Exercises - running, swimming, yoga

Smoking cessation, reduce alcohol/caffeine intake

Maintain BMI <30, balanced diet

Question 24

Outline the types of HRT

Answer 24

Sequential = within 12m of last period, minimises risk of irregular bleeding

Continuous combined = no period for 12m, can get bleeding first 3m

Tibolone

Vaginal oestrogen = pessaries, cream, ring - improve vaginal and urinary symptoms

Question 25

Which type of HRT is given in which circumstance?

Answer 25

Transdermal oestrogen = hysterectomy

Micronized progesterone, Mirena IUS = no hysterectomy (protect endometrium)

Oral = pts that tried transdermal with no effect

Question 26

What are the non-hormonal treatments for the menopause?

Answer 26

Vaginal lubricants and moisturisers

Alternative - acupuncture, reflexology, homeopathy

Psychological - CBT