Menopause and post-reproductive health

Question 1

whats the definition of the menopause

Answer 1

permanent cessation of menstruation, starts 12 months after the last menstrual period

Question 2

what is the average age the menopause starts

Answer 2

51

Question 3

what is the definition of the perimenopause

Answer 3

time at which the menopause begins, ends after 12 months of amenorrhea

Question 4

what is premature menopause defined as

Answer 4

<40 years old

Question 5

what are common causes of premature menopause

Answer 5

Bilateral oorphrectomy

Infection

Autoimmune

Chemo

Metabolic disease

Ovarian dysgenesis

Question 6

what must be excluded for post menopausal bleeding

Answer 6

endometrial cancer or cervical cancer in younger menopausal patients

Question 7

how should you investigate a post-menopausal bleeding patient

Answer 7

bimanual exam
cervical inspection and smear
transvaginal ultrasound

Question 8

when should you biopsy an endometrium on transvaginal ultrasound

Answer 8

<4mm + 1 episode = no biopsy

<4mm + 2+ episodes = biopsy

> 4mm = biopsy

Question 9

what is the most likely benign cause for post menopausal bleeding

Answer 9

atrophic vaginitis

Question 10

whats the treatment for atrophic vaginitis

Answer 10

topicla oestrogen or

oral ospemifine

Question 11

what are some symptoms/consequences of the menopause

Answer 11

vasomotor symptoms (hot flushes) - 70%
urogenital issues
sexual problems (lack of interest) - 50%
osteoporosis

Question 12

what are common urinary symptoms related to the menopause

Answer 12

Frequency

Urgency

Nocturia

Incontinence

Recurrent infections

Question 13

what are some common investigations for the menopause

Answer 13

FSH levels - increased as oocytes decrease

antimullerian hormone - sign of ovarian reserve, low=ovarian failure

TSH/free t4
catecholamines - both can mimic some menopause signs

LH,oestrogen,progesterone - low progesterone = anovulation

bone density if at risk

Question 14

what is the appropriate HRT drug for a woman without a uterus

Answer 14

pure oestrogen

Question 15

what is the appropriate HRT drug for a woman with a uterus + why

Answer 15

oestrogen and progesterone , oestrogen on its own causes endometrial hyperplasia and carcinoma

Question 16

what is an appropriate HRT regime for a perimenopausal woman

Answer 16

sequential or cyclical therapy

IUS is helpful if there is heavy bleeding

Question 17

what is an appropriate HRT regime for a postmenopausal woman + why

Answer 17

continuous therapy due to risk of endometrial carcinoma

Question 18

benefits of oestrogen only HRT

Answer 18

Menopausal symptoms all tend to get better with oestrogen within roughly 4 weeks (except libido)

Osteoporosis risk is reduced

Colorectal cancer risk reduced by 1/3

Question 19

risk of oestrogen-only HRT

Answer 19

Slightly increased breast cancer risk

Endometrial cancer risk is increased In oestrogen only regimes

Increased VTE risk (2x in women >50)

Gallbladder disease risk increased

Question 20

what is the general duration of therapy for HRT

Answer 20

If used for menopausal symptoms treatment is typically 5 years

If osteoporosis is used treatment is often lifelong

If premature menopause treatment is used until they reach the median age of menopause (51 years)

Question 21

what are some alternative treatments for menopause symptoms (mainly hot flushes and night sweats)

Answer 21

Progestogens

Clonidine (Alpha adrenoreceptor agonist)

SSRIs or SNRIs