Menopause

Question 1

How can menopause be diagnosed?

Answer 1

Retrospectively when the period has stopped for more than 12 months

Question 2

At what age does menopause typically occur?

Answer 2

51

Question 3

When typically is perimenopause?

Answer 3

From the age of 45 onwards

Question 4

At what age is it counted as premature menopause?

Answer 4

If before the age of 40

Question 5

What is the phyiology behind the menopause?

Answer 5

When menopause begins there is a reduced development of the ovarian follicles.
This results in reduced oestrogen production by the follicles.
As oestrogen causes negative feedback to the pituitary suppressing LH and FSH, they will go up in the absence of oestrogen

Question 6

What are the symptoms that low oestrogen levels cause?

Answer 6

Hot flushes
Low mood
Irregular periods
Joint pains
Heavier or lighter periods
Vaginal dryness and atrophy
Reduced libido

Question 7

What does the lack of oestrogen in menopause increase the risk of?

Answer 7

Cardiovascular disease and stroke
Pelvic organ prolapse
Osteoporosis
Urinary incontinence

Question 8

How can a diagnosis of menopause be formally made?

Answer 8

In women over 45 this can be diagnosed with typical symptoms and there is no need for further investigation.
NICE recommend an FSH blood test in women under 40 with suspected premenopause or 40-45 with menopause symptoms or change in the menstrual cycle

Question 9

When should women continue to use contraception in menopause?

Answer 9

For 2 years after the last period if under 50

For one year after the last period in over 50

Question 10

How do hormonal contaceptives affect the menopause?

Answer 10

They do not affect when it occurs or how long it lasts but they may mask symptoms, this can make diagnosis more difficult

Question 11

What are the two main side effects of the progesterone depot injection?

Answer 11

Weight gain and reduced bone mineral density, this makes it unsuitable for women over 45

Question 12

What are the best contraceptive methods for women approaching the menopause?

Answer 12

Barrier methods, mirena or copper coil, progesterone only pill, progesterone injection, sterilisation are all UKMEC 1
CHC is UKMEC2 after age 40 and can be used up to 50 years

Question 13

What are the options to manage menopausal symptoms?

Answer 13

HRT
tibolone - synthetic steroid hormone that acts as continuous HRT (only after 12 months amenorrhoea)
Clonidine - alpha agonist to reduce hot flushes
CBT for mood
SSRIs for mood - fluoxetine or citalopram
testosterone cream or gel can be used for libido
Vaginal oestrogen cream or tablets can help vaginal dryness and atrophy
Vaginal moisturisers can be used