Menopause

Question 1

Diagnosis of menopause

Answer 1

Retrospective
made after a woman has not had a period for 12 months- a permanent end to menstruation

on average, 51 years old but can vary significantly

Question 2

menopausea
post menopause
perimenopause

Answer 2

• menopause- menstruation stops
• post menopause- the period from 12 months after final menstrual period onwards
• perimenopause: the time around the menopause, may be experiencing vasomotor symptoms, irregular periods. typically in women >45 years old

Question 3

physiology of menopause

Answer 3

lack of ovarian follicular function
change in sex hormones associated with the menstrual cycle

oestrogen and progesterone levels are low
LH and FSH are high (in response to an absence of negative feedback from oestrogen)

Question 4

perimenopausal symptoms

Answer 4

Hot flushes
Emotional lability or low mood
Premenstrual syndrome
Irregular periods
Joint pains
Heavier or lighter periods
Vaginal dryness and atrophy
Reduced libido

risks: A lack of oestrogen increases the risk of certain conditions:

Cardiovascular disease and stroke
Osteoporosis
Pelvic organ prolapse
Urinary incontinence

Question 5

menopause- contraception

Answer 5

fertility declines after 40 y/o but women should still consider themselves fertile

<50 y/o, continue contraception for 2 years after the last menstrual period

> 50 y/o continue contraception for 1 year the last menstrual period

Question 6

menopause- contraception

Answer 6

fertility declines after 40 y/o but women should still consider themselves fertile

<50 y/o, continue contraception for 2 years after the last menstrual period

> 50 y/o continue contraception for 1 year the last menstrual period

Question 7

contraceptive options for women in the menopause

Answer 7

Barrier methods
Mirena or copper coil
Progesterone only pill
Progesterone implant
Progesterone depot injection (under 45 years)
Sterilisation

COCP can be used to the age of 50 if no other contraindications (norethisterone, levongesterol in women over 40, lower risk of VTE)

Question 8

Depo provero

Answer 8

weight gain, reduced bone mineral density

this makes it unsuitable for women >45 y/o

Question 9

perimenopausal symptom mx

Answer 9

vaso-motor resolve after 2-5 years without reatment
management depends on severity

No treatment
Hormone replacement therapy (HRT)
Tibolone, a synthetic steroid hormone that acts as continuous combined HRT (only after 12 months of amenorrhoea)
Clonidine, which act as agonists of alpha-adrenergic and imidazoline receptors
Cognitive behavioural therapy (CBT)
SSRI antidepressants, such as fluoxetine or citalopram
Testosterone can be used to treat reduced libido (usually as a gel or cream)
Vaginal oestrogen cream or tablets, to help with vaginal dryness and atrophy (can be used alongside systemic HRT)
Vaginal moisturisers, such as Sylk, Replens and YES