Menopause

Question 1

Menopause is considered premature if a woman is ____ years of age

Answer 1

<40

Question 2

A woman is considered menopausal if she is ___ years of age and amenorrheic for ____. OR ____ years of age and amenorrheic for ____.

Answer 2

A woman is considered menopausal if she is >50 years of age and amenorrheic for >1 year. OR <50 years of age and amenorrheic for >2 yrs

Question 3

List 4 risk factors for early menopause

Answer 3

smoking
surgery
chemotherapy
radiation

Question 4

List 8 signs and symptoms of menopause

Answer 4

• hot flashes/flushes (+/- sweating + palpitations) lasting 2-30min
• vaginal dryness/discomfort, dyspareunia, dysuria, more UTIs (urogenital atropy)
• sleep disturbance (secondary to night sweats)
• skin changes (thinning, decreased elasticity)
• mood disorder (depression, anxiety, irritability)
• cognitive disturbance (forgetful)
• somatic complaints (back pain, stiffness)
• urinary incontinence
• vertigo/HA
• palpitations
• sexual dysfunction

Question 5

Since menopause is a clinical disorder, what are the criteria by which you would order laboratory investigations?

Answer 5

• if the diagnosis is equivocal
• the patient is not on hormones
• suspected menopausal symptoms <45 years, and especially if <40
• atypical symptoms

Question 6

You need to obtain further tests. What are the important laboratory investigations you would order if you are suspecting menopause?

Answer 6

FSH (>30mIU/ml)
LH 
TSH
Prolactin
Beta-hCG 
estradiol

Question 7

What is your differential diagnosis in a woman who is presenting with hot flashes, and night sweats?

Answer 7

• stress
• panic attack
• alcohol
• thyroid
• infection
• carcinoid syndrome
• pheochromocytoma
• leukemia
• neoplasm

Question 8

What are some lifestyle modifications that you can suggest to a perimenopausal woman experiencing vasomotor symptoms?

Answer 8

smoking cessation 
decrease etOH intake 
exercise 
dress in layers
fan
avoid hot drinks
ice pack under pillow
optimize sleep 
cool environment

Question 9

what are some lifestyle modifications that you can suggest for a perimenopausal woman who is experiencing urogenital symptoms?

Answer 9

vaginal moisturizer/lubricant
regular sexual activity (increases blood flow)
kegel exercises
pessary for symptoms of incontinence

Question 10

What can you prescribe a woman who is perimenopausal who has had their LMP <1 year ago?

Answer 10

low-dose OCP or progestins for vasomotor symptoms and treating with cyclic regime

Question 11

What are some side effects of hormonal therapy for menopause?

Answer 11

breast tenderness
uterine bleeding 
n/v 
h/a 
wt change 
dizziness 
VTE
CV event 
pruritis 
cholecystitis 
liver effects

Question 12

What are the absolute contraindications for systemic estrogen?

Answer 12

pregnancy 
unexplained vaginal bleeding 
known or suspected breast Ca 
liver disease 
acute cardiovascular disease 
CAD
stroke 
immobilization 
CA
recent VTE
increased cholesterol 
migraine with aura

Question 13

Name 4 classes of medications that can be used to treat vasomotor symptoms in menopause

Answer 13

Hormone replacement therapy 
Selective serotonin reuptake inhibitor (SSRI) 
anticonvulsants 
Tricyclic antidepressants
Progestin 
Oral Contraceptive Pill

Question 14

What are the HRT contraindications?

Answer 14

A - Active liver disease
B - Bleeding (undiagnosed vaginal bleed)
C - Cancer (hormone sensitive), CHD, Clot (past stroke)
D - DVT

Question 15

How long can a patient stay on HRT? why?

Answer 15

5 years. After 5 years risk of breast cancer goes up