Menopause

Question 1

What is menopause?

Answer 1

permanent cessation of the menstrual cycle for 12 months (diagnosed retrospectively)

Question 2

What is perimenopause?

Answer 2

The time from the onset of ovarian dysfunction to diagnosis of menopause

(the time around menopause)

Question 3

What is the average age for menopause in UK?

Answer 3

51

Question 4

What is the age interval for menopause?

Answer 4

45-55

Question 5

What occurs to GnRH during menopause?

Answer 5

First increases in perimenopause

Then decreases > overall reduction long term

Question 6

What occurs to LH and FSH during menopause?

Answer 6

Increases

Progressive decline as person becomes elderly

Question 7

What occurs to oestrogen and progesterone during menopause?

Answer 7

DECLINE

Question 8

What are oestrogen levels like in the elderly?

Answer 8

Very low

Question 9

What are progesterone levels like in the elderly=?

Answer 9

Undetectable

Question 10

What occurs to inhibit during menopause?

Answer 10

Declines to an undetectable level

Question 11

What is premature ovarian insufficiency?

Answer 11

Menopause before the age of 40

Question 12

What is the option for conception in premature ovarian insufficiency=

Answer 12

Egg donation

Question 13

What are causes of premature ovarian insufficiency?

Answer 13

Primary:

• chromosomal abnormalities (Turner’s, fragile X)
• Autoimmune disease (hypothyroid, Addisons, myasthenia graves)
• Enzyme deficiency

Secondary:
- Chemotherapy/radiotherapy
Infections

Question 14

What is the main cause of POI?

Answer 14

UNKNOWN in 90% of patients = IDIOPATHIC

Question 15

How is POI diagnosed?

Answer 15

2 FSH readings 4-6 weeks apart

FSH will be high in both

Question 16

What is treatment for POI?

Answer 16

Supportive care and counselling

• HRT/COCP for bone health and CVD protection
• ART(egg donation + IVF) for infertility

Question 17

What are immediate symptoms of menopause?

Answer 17

vasomotor - hot flushes, night sweats
psychological - labile mood, anxiety, tearfulness
neuro - poor memory, loss of concentration
MSK - joint aches and pains
derm - dry and itchy skin
decreased libido

Question 18

Whatare intermediate symptoms of menopause=

Answer 18

vaginal dryness, dysparaeunia
urgency of urine
Recurrent UTI
urogenital prolapse

Question 19

What are long term symptoms of menopause?

Answer 19

osteoporosis
CVD
dementia

Question 20

Why do vasomotor symptoms occur in menopause?

Answer 20

due to exaggerated peripheral vasodilation to slight changes in external temperature

Question 21

What are triggers for vasomotor symptoms?

Answer 21

alcohol, caffeine, sweating

Question 22

How does fat distribution change in menopause?

Answer 22

from gyanecoid (breast and hip fat) 
to android (abdominal fat)

Question 23

How do CVD risk factors change in menopause?

Answer 23

reduction in HDL

Increase in triglycerides, cholesterol, LDL

Question 24

What is conservative management of menopause?

Answer 24

normal BMI
stop smoking
reduce alcohol consuptption

Question 25

What are non hormonal treatments for menopause?

Answer 25

``` alpha agonist e.g. clonidine beta-blocker e.g. propanolol SSRI (for vasomotor symptoms) vaginal moisturiser /lubricant osteoporosis treatment (buphosphonate, raloxifene) ```

Question 26

What kind of hormones are used in HRT, and in what combination?

Answer 26

OESTROGEN ONLY if no longer has a uterus | OESTROGEN + PROGESTERONE otherwise (can be CYCLICAL or CONTINOUS COMBINED)

Question 27

What is the function of progesterone in HRT?

Answer 27

Protects the endometrium from cancer

Question 28

What are routes of hormone therapy administration?

Answer 28

Oral / transdermal / coil / gel

Question 29

What is the benefit of transdermal route?

Answer 29

It bypasses the liver

Question 30

What are absolute contraindications for HRT?

Answer 30

``` Suspected pregnancy Breast cancer Endometrial cancer Active liver disease Uncontrolled HTN LVTE Thrombophilia Otosclerosis ```

Question 31

How does HRT affect cancer?

Answer 31

It does not drastically increase breast cancer | It just promotes growth of the cancer cells

Question 32

What is the hormone that increases risk of breast cancer?

Answer 32

Progesterone

Question 33

What is the hormone that increases risk of endometrial cancer?

Answer 33

Oestrogen

Question 34

Why do you need to give progesterone in HRT ?For which women is this necessary?

Answer 34

In women who have a uterus / with endometriosis tissue | It protects against endometrial cancer

Question 35

What is cyclical HRT composed of?

Answer 35

Oestrogen continuously | Progesterone only on day 0-12

Question 36

What women is cyclical HRT appropriate for'

Answer 36

LMP <1 yr prior / still having periods | Good for POI to preserve fertility

Question 37

What women is continuous combined HRT appropriate for

Answer 37

Women with LMP >2 yrs prior

Question 38

What is the benefit of continuous combined HRT compared to cyclical?

Answer 38

Continuous progesterone reduces risk of endometrial cancer BUT It increases risk of breast cancer

Question 39

What is the impact of HRT on CVD?

Answer 39

Depends on women's age - younger;: protective - older: increases risk

Question 40

What women can HRT be prescribed to ?

Answer 40

Women in the WINDOW OF OPPORTUNITY - <60 years old - within 10 years of menopause onset

Question 41

How. do you follow up a woman after her first HRT dose?

Answer 41

Recall 3 months after starting - to see if trial works | Every 12 months review (BP; breast exam, vaginal exam, mammograpy)

Question 42

How long do you leave a woman on HRT for?

Answer 42

The least duration of time possible

Question 43

What kind of HRT does not have increased VTE risk?

Answer 43

TRANSDERMAL

Question 44

what is the effect of adding a progesterone to HRT on VTE?

Answer 44

Adding a Progesterone will INCREASE VTE risk

Question 45

What kind of progesterone in HRT will reduce risk of endometrial cancer

Answer 45

CONTINUOUS combined (so continuous progesterone)

Question 46

What kinds of cancer does estrogen cause

Answer 46

Endometrial | Ovarian

Question 47

What kinds of cancer does progesterone cause

Answer 47

Breast, cervical

Question 48

What cancer is progesterone protective for

Answer 48

Endometrial