Menopause

Question 1

What is menopause?

Answer 1

cessation of periods

Question 2

Explain premenopause, perimenopause and postmenopause?

Answer 2

premenopause= regular periods
perimenopause= irregular period
postmenopause= no periods > 12 months

Question 3

What is the average age of UK menopause?

Answer 3

51 yo

Question 4

Define premature ovarian insufficiency?

Answer 4

menopause < 40

Question 5

Define early menopause? What percentage of women have early menopause?

Answer 5

age 40-44

5%

Question 6

Percentage of women who experience severe menopause symptoms is ______
On average women experience ____ symptoms
ON average they last ______

Answer 6

85%
7
7.4 years

Question 7

When are menopause symptoms most severe?

Answer 7

in late peri and early post menopause

Question 8

Most menopause symptoms improve with time except _______

Answer 8

GUM problems e.g. dry vagina, painful sex and urinary problems

Question 9

What are the symptoms of menopause? What are the top three?

Answer 9

Top 3:
hot flushes, night sweats, mood swings

Others:
brain fog, period problems, anxiety, dizziness, memory loss, dry skin and hair, aches and pains, weight gain, tiredness, lack of energy, palpitations, recurrent UTI symptoms, pins and needles, insomnia, decreased libido, headaches, painful sex, irritability

Question 10

Explain what is meant by perimenopause?

Answer 10

the period before menopause- many women develop symptoms years before their last period

Question 11

What testing is needed in those presenting with symptoms of perimenopause?

Answer 11

no routine FSH need in those 45 or over as FSH fluctuates at this point anyway
FSH x 2 (6 weeks apart) is indicated in women > 45 with atypical symptoms or in women between 40-45 with menopausal symptoms and/ or iatrogenic amenorrhoea (endometrial ablation or hysterectomy)
FSH, E2, glucose, prolactin and FAI should be checked in women < 40, in women less than 35 should also check chromosomes and exclude autoimmune causes

Question 12

Overview of management of menopause?

Answer 12

lifestyle changes
CBT for hot flushes
environment changes
non hormonal treatment: herbal medicine, SSRIs/ SNRIs, complementary medicine (e.g. acupuncture, homeopathy, hypnotherapy)
HRT

Question 13

Benefits of HRT?

Answer 13

increased quality of life, improved symptoms 
increased mental health
increased sexual health 
decreased osteoporosis
decreased CVD disease until age 60

Question 14

Negatives of HRT?

Answer 14

increased breast cancer risk
increased VTE risk if taken PO
Increased CVD risk > 60

Question 15

Contraindications of HRT?

Answer 15

history of breast cancer
coronary heart disease
TIA or previous stroke 
unexplained vaginal bleeding 
active liver disease

Question 16

Explain what HRT you give to people?

Answer 16

If hysterectomy or mirena in situ only need oestrogen

If have uterus and no mirena then need oestrogen and progesterone, if perimenopausal then give sequential therapy, if postmenopausal give continuous combined therapy, need the progesterone to stop endometrial hyperplasia which could progress to cancer

Question 17

How long can you give HRT for?

Answer 17

There is no time limit on HRT, can either gradually reduce or immediately stop
in those with early menopause or POI strongly advise giving HRT until at least 51

Question 18

Perimenopausal contraception in someone under 40?

Answer 18

POI may be transitional, continue contraception

Question 19

Perimenopausal contraception in those age 40-49?

Answer 19

stopped 2yrs after last natural period or if on contraception that is hormonal 2 years after 2 results of FSH > or equal to 30 taken 4-6 weeks apart

Question 20

Perimenopausal contraception in those age 50-54?

Answer 20

stopped 1yr after last natural period or if on contraception that is hormonal 1 year after 2 results of FSH > or equal to 40 taken 4-6 weeks apart

Question 21

Perimenopausal contraception in those 55 or over?

Answer 21

can stop even if still having periods

Question 22

What is vulvo-vaginal atrophy?

Answer 22

thinning, drying and inflammation of the vaginal walls due to less oestrogen

Question 23

Symptoms of vulvo vaginal atrophy?

Answer 23

can cause dryness, soreness, irritation, dyspareunia, urge incontinence

Question 24

What is vulvo vaginal atrophy treated with?

Answer 24

topical oestrogen (v little risk) which can be used for as long as needed