Menopause

Question 1

What is Menopause?
→ When is it diagnosed?

What is Perimenopause/Menopausal transition?

What is Premature Ovarian Insufficiency?

What is Early Menopause?

Answer 1

• Permanent cessation of menstruation due to loss of Ovarian follicular activity (mean age - 51)
  → Diagnosed after 12 months of Amenorrhoea
• Irregular cycles and characteristic symptoms of menopausal transition
• Menopause < 40YRS
• Menopause between 40-45YRS

Question 2

SYMPTOMS:
What are they in Perimenopause?
→ How long can they last?

What are they in Early Post-menopause?

What are they at increased risk of Long-term?

What can be given for the Urogenital symptoms?

What can be given for Altered sexual function?

What can be given for the Vasomotor symptoms?

What can be given for the Mood disorders?

Answer 2

• • Vasomotor - Hot flushes and Night sweats (Sleep disturbance)
  • Cognitive impairment, Anxiety and Mood disorders, Altered sexual function, Joint/Muscle aches, Headaches, Fatigue
  → 6-10 years
• Genitourinary Syndrome:
  o Vaginal irritation - Dryness, Itch, Burning, Painful sex
  o Urinary tract disorders - Dysuria, Frequency and Urgency, Recurrent UTI
• • Heart - CVD, Stroke, TIA
  • Bone - Osteoporosis, Fracture
• Vaginal Oestrogen and Moisturiser
• Testosterone
• SSRIs, CBT
• Anti-depressants, CBT

Question 3

MECHANISM:
What’s the effect of the Reduced follicle count?

What does the ↓Oestrogen cause?

INVESTIGATION:
What do you do when they’re <45yrs?
→ What should FSH levels be?

What do you do when they’re >45yrs?

Answer 3

• ↓Oestrogen levels and less negative feedback, leading to ↑LH/FSH
• • Oestrogen levels too low to stimulate the Endometrium = Amenorrhoea
  • ↓Oestrogen causes Vasomotor symptoms (Hot flushes, Night sweats)

• History and Bloods
  o FSH levels, Repeat at least 4 weeks apart
  → Should be >30 iu/L
  o Make sure they’re not on COCP/HRT
  o If level is pre-menopausal, repeat in a year
• Check Periods and Symptoms

Question 4

PREMATURE OVARIAN INSUFFICIENCY:
What is it?

What are its types of causes?

How are they managed?

What else can they be given?
→ Only when is this suitable to give?

Answer 4

• Loss of ovarian function <40YRS
• Genetic, Autoimmune, Iatrogenic, Idiopathic
• Put on HRT/COCP until around 51yrs
• Testosterone
  → If Bilateral Oophorectomy (removal of ovaries)

Question 5

HORMONE REPLACEMENT THERAPY:
Why is the Oestrogen given?

Why is the Progesterone given?

What are its routes of administration?

When is it given Cyclically or Continuously?

What are its benefits?

What are its side-effects?

What does it increase the risk of? What does this risk increase with?

Answer 5

• For symptoms
• To protect the Endometrium
• Patches, Gel, Tablets, IUDs, Testosterone implants, Vaginal
• • Cyclical if LMP within last year
  • Continuous if LMP over a year ago
• Treat vasomotor symptoms, Protect urogenital system, Maintain cognition, Reduce osteoporotic fractures, Improve muscle mass/strength
• Headache, Breast tenderness
• • Breast cancer - Risk increases with prolonged use
  • Ovarian cancer
  • VTE/Stroke - Risk increases with oral preparations
  • Cardiovascular disease - Risk increases if they start HRT >60yr