Menopause

Question 1

definition of menopause for a woman over 45 and a woman under 45

Answer 1

over 45 - cessation of menses for 12+ months with no other cause
under 45 - cessation of menses for 24 months with no other cause

Question 2

Symptoms of menopause

Answer 2

hot flushes & night sweats
loss of libido
vaginal dryness 
low mood/anxiety 
frequency of micturition, urgency and nocturia 
arthralgia, mlyalgia 
poor sleep/insomnia 
skin and hair dryness, thinner hair 
lethargy, fatigue

Question 3

What causes menopause

Answer 3

depletion of ovarian follicles until there are none left, follicles also become less sensitive to FSH and LH over time

Question 4

What is peri-menopause

Answer 4

a couple of years of hormonal changes before menopause in which symptoms begin to arise

due to less follicles in the ovaries so cycles are often anovulatory causing missed/irregular periods

Question 5

What happens hormonally to cause the symptoms of menopause

Answer 5

Follicles are absent so less oestrogen and progesterone and so inhibition of the hypothalamus and pituitary

this causes higher frequency, larger bursts of GnRH, FSH and LH

The erratic hormone secretion and lack of oestrogen leads to symptoms

Question 6

What are the long term effects of oestrogen deficiency

Answer 6

• CVD risk as oestrogen is protective to the cardiovascular system
• Osteoporosis as oestrogen sustains bone density

Question 7

How does menopause resolve

Answer 7

the body adjusts to hormonal changes so symptoms go away on their own in a couple of years

Question 8

What are the different types of HRT and which subsets of women are they prescribed to

Answer 8

• combined (progesterone and oestrogen) - for women who have a uterus; treatment routine can be cyclical or continuous
• oestrogen only - for women who have no uterus (hystectomy); take eostrogen everyday w/o a break

Question 9

HRT routes of administration

Answer 9

oral tablets
transdermal - patch or gel
IUS - for progesterone component
vaginal oestrogen cream for vaginal symptoms (given w/o progesterone)

Question 10

Benefits of HRT

Answer 10

eases menopausal symptoms
reduces CVD risk
protects bone mineral density

Question 11

Risks of orally administered HRT

Answer 11

increased risk of blood clots so increased risk of DVT, PE, stroke, MI

Question 12

Why do we not give unopposed oestrogen to women with a uterus

Answer 12

increased risk of endometrial cancer

Question 13

Cancer risk from HRT?

Answer 13

Increased risk of breast cancer - 1 in 1000 per year