Menopause

Question 1

What are the stages of menopause?

Answer 1

Premenopause = regular periods
Perimenopause = irregular periods
Postmenopause = no periods >12 months

Question 2

What is the average age of menopause onset?

Answer 2

Age 51

Question 3

What age would be defined as early menopause?

Answer 3

Between age 40-44 = occurs in 5% of women

Question 4

What age would be defined as premature ovarian insufficiency (POI)?

Answer 4

Onset

Question 5

What are some features of the symptoms of menopause?

Answer 5

85% of women have symptoms
Average symptom duration = 7.4 years
Average number of symptoms = 7

Question 6

When are the symptoms of menopause most severe?

Answer 6

In late perimenopause and early postmenopause = have major effect on home, work, family, socialand sex life

Question 7

Do the symptoms of menopause get better over time?

Answer 7

Largely yes = exception is GU problems (dry vagina, painful sex, urinary symptoms)

Question 8

What are the major symptoms of menopause?

Answer 8

Mood swings, nights sweats and hot flushes

Question 9

What are some of the associated symptoms of menopause?

Answer 9

Loss of sex drive, insomnia, lack of energy, headaches, pins & needles, recurrent UTI symptoms, painful sex, irritability, depression, palpitations, tiredness, weight gain, aches & pains, memory loss, dizziness, anxiety

Question 10

What is perimenopause?

Answer 10

Menopausal symptoms occurring before last period

Question 11

Should women >= age 45 be routinely tested for FSH?

Answer 11

No = exception is women >=50 on hormonal contraception who don’t want to continue until age 55

Question 12

What can help diagnose perimenopause?

Answer 12

Menopause symptom chart = also useful for tracking symptoms

Question 13

What medications should menopausal women <45 be on?

Answer 13

HRT or CHC for bone health

Question 14

What women should have their FSH levels measured twice 6 weeks apart?

Answer 14

Women >45 with atypical symptoms

Women between 40-45 with symptoms and/or iatrogenic amenorrhoea

Question 15

What should be checked in menopausal women aged <40?

Answer 15

FSH, E2, TFT, glucose, prolactin and FAI

Also check chromosomes

Question 16

What should be excluded in menopausal women aged <35?

Answer 16

Autoimmune disorders

Question 17

What are some lifestyle changes recommended to help menopausal symptoms?

Answer 17

Healthy diet (including phytoestrogens) and weight
Regular exercise and good sleep hygiene
No smoking and limited alcohol and caffeine
Reducing stress and CBT

Question 18

What are some changes to the patient’s environment that may help menopausal symptoms?

Answer 18

Cooler ambient temperature, good ventilation, suitable clothing, neck cooling scarf, cooling spray

Question 19

Are non-hormonal treatments for menopause effective?

Answer 19

Debatable = limited effectiveness and scope of symptom relief

Question 20

What are some non-hormonal treatments for menopause?

Answer 20

Herbal medicine = St Johns wort, black kohosh
SRRIs/SNRIs and gabapentin = help in up to 66%
Acupuncture, homeopathy, aromatherapy, acupressure

Question 21

What are the benefits of HRT?

Answer 21

Increased quality of life, improved mental and sexual health, reduces osteoporosis, reduces CVD (up until age 60)

Question 22

What does HRT increase the risk of?

Answer 22

Breast cancer, VTE and CVD (if age >60)

Question 23

What can be used to treat and prevent vulvovaginal atrophy?

Answer 23

HRT = can also be treated with topical oestrogen

Question 24

What are the contraindications to using HRT?

Answer 24

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

Question 25

How is HRT used in women with premature ovarian insufficiency?

Answer 25

Give HRT until average age of menopause = continuous CHC could be used as alternative, continue use of contraception

Question 26

How is HRT used in women with early menopause?

Answer 26

Strongly consider giving HRT until average age of menopause

Question 27

What kind of HRT is used in women who have had a hysterectomy or mirena in situ?

Answer 27

Oestrogen only Oral = oestradiol or conjugated equine oestrogens Transdermal = gel, patch, spray

Question 28

What kind of HRT is used in women who haven't had a hysterectomy or mirena in situ?

Answer 28

Oestrogen + progestogen Sequential therapy if perimenopausal Continuous therapy if postmenopausal

Question 29

What is the first line treatment for vasomotor symptoms and low mood/anxiety related to menopause?

Answer 29

HRT

Question 30

What are the benefits of transdermal HRT?

Answer 30

Low/no increased risk of VTE Better for symptom control Associated with less CVD risk

Question 31

What are the indications for transdermal HRT?

Answer 31

Individual preference Poor symptom control with oral HRT GI disorder affecting oral absorption or migraine Increased VTE risk or variable blood pressure control Current use of hepatic enzyme-inducer Gallbladder disease

Question 32

What are the side effects of oestrogenic hormones?

Answer 32

Bloating, breast enlargement and tenderness, fluid retention, headaches, leg cramps, mood swings, nausea

Question 33

What are the side effects of progestogenic hormones?

Answer 33

Acne, anxiety, bloating, breast tenderness, depression, headaches, hirsutism, lower abdo/pelvic/back pain, mood swings

Question 34

Should contraception be stopped in perimenopausal women age <40?

Answer 34

No = PIO may be transitional

Question 35

When should contraception be stopped in a perimenopausal woman aged 40-49?

Answer 35

2 years after last natural menstrual period | 2 years after two FSH results >=30 UI/l (taken at least 4-6 weeks apart)

Question 36

When should contraception be stopped in a perimenopausal woman aged >=50?

Answer 36

1 year after last natural menstrual period | 1 year after one FSH result >=30 IU/l

Question 37

Should contraception be stopped in a perimenopausal woman aged >=55?

Answer 37

Yes = even if still having periods (due to poor oocyte quality)

Question 38

When would you continue giving contraception to a perimenopausal woman aged >=55?

Answer 38

May continue for a year or two if periods are troublesome

Question 39

What is used to treat vulvovaginal atrophy?

Answer 39

``` Vaginal oestrogen (includes women on systemic HRT) Moisturisers and lubricants may also be used ```

Question 40

Can vulvovaginal atrophy relapse after treatment is stopped?

Answer 40

Yes = symptoms may return after treatment stops

Question 41

Should women with vulvovaginal atrophy have their endometrial thickness routinely monitored?

Answer 41

No

Question 42

What should be used to treat vulvovaginal atrophy in women in whom systemic HRT is contraindicated?

Answer 42

Vaginal oestrogen = exception is when there is a history of breast cancer