Menopause and HRT

Question 1

How long do females have to go without periods to be classed as menopausal?

Answer 1

12 months

Question 2

What is perimenopausal? What happens during it?

Answer 2

4 years before menopause
Complex endocrinology changes during the menopausal transition
Changes to the menstrual cycle varies
Low levels of oestrogen
Ovulating less frequently
Anovulatory cycles

Question 3

What is the median age for menopause?

Answer 3

51.5 yrs

Question 4

What causes menopause? (physiology behind it)

What causes variable menstrual cycle length during menopausal transition?

Answer 4

From loss of ovarian sensitivity to gonadotrophin stimulation
Variable MC length due to shrinking follicle cohort size than to follicle failure

Question 5

What happens to the follicles over time?

Answer 5

1.2 million follicles at birth
1000 left by menopause
Mostly lost by atresia not ovulation
Atresia increases from age 35-ish

Question 6

What is the classic symptom triad of menopause?

Answer 6

Hot flushes (vaso-motor instability)
Sweats
Vaginal Dryness (urogenital tissues are oestrogen sensitive)

Question 7

What are some non-specific symptoms of menopause?

Answer 7

Headaches, Migraines, Palpitations, Disturbed sleep
Joint & muscle aches
Vaginal dryness, Cystitis, Urinary frequency, Urinary incontinence
Loss of concentration, Poor memory, Irritability, Loss of libido, Panic attack
Skin thinning, Hair loss, Brittle nails, Aches and pains, osteoporosis

Question 8

How can you diagnose menopause?

Answer 8

Clinical: age, symptoms and signs
If age < 40, do a blood test - use FSH as marker
FSH > 30mIU/ml
Absence of menses for 12 months
Consider premature menopause or premature ovarian failure (POF)

Question 9

What is the treatment for menopause?

Answer 9

Combined HRT orally
Uterus present - progesterone - due to risk of endometrial cancer
DXA scan - joint pain
Osteopenia
Bisphosphonate (Fosamax)