Menopause and Premature Ovarian Insufficiency ☺️

Question 1

Gonadal function decline in males and females

Answer 1

Males-none

Females

• gamete exhaustion
• sudden decrease in fertility
• senescent changes in reproductive activity

Question 2

Difference between

• Menopause
• Perimenopause
• POI

Answer 2

Menopause - 12 months of amenorrhea
-no O -ve feedback => high FSH

Perimenopause - irregular cycles, symptoms

POI - transient/permanent loss of ovarian function before 40 leading to menstrual irregularities

Question 3

Presentation

Answer 3

Irregular heavy bleeds

Hot flushes, night sweats
Low mood, irritability
Dry vagina, vulva atrophy, low libido
Joint pain
Headaches

Long term

• osteoporosis
• increased CVD risk

Question 4

Investigations

How would you manage menopause

• non hormonal
• hormonal

Answer 4

Typically a clinic diagnosis especially if

• perimenopause - irregular periods, hotflushes
• menopause - no period for 1 year + hormonal contraception

FSH => elevated

• if presenting atypically/younger
• 2 samples needed 4wks apart for POI

Question 5

Management - lifestyle

Answer 5

• regular exercise, weight loss
• avoid triggers
• keep house cool
• sleep hygiene

Question 6

Management - hormonal

-types

Answer 6

HRT for hot flushes/night sweats/headaches/insomnia

• O => symptomatic relief
• P => endometrial protection against unopposed O
• T => increase energy, libido

Continuous O, P => no bleeds

Sequential (intermittent P) => bleeds

• offered to perimenopausal
• offered cont after 2 years

Question 7

Pros and cons of HRT

Answer 7

Pros

• symptomatic relief
• osteoporosis protection
• endometrial cancer risk low if P used
• HDL increased, LDL decreased

Cons

• breast, ovarian cancer
• VTE (CVD and stroke)

Question 8

Management - non hormonal

Answer 8

Vasomotor - SSRI/SNRI/clonidine (a2agonist)
Mood - CBT/antidepressants
Urogenital - vaginal lubricants

Question 9

POI causes

-management

Answer 9

Idiopathic (most common)
Genetic (FHx)
AI
Iatrogenic (chemo, radio, bilateral oophorectomy)

HRT/COCP
Fertility treatment
Psychological support

Question 10

How does COCP work?

What are the pros and cons

Answer 10

COCP

• stops ovulation
• thickens cervical mucus
• thins endometrial lining

Advantages

• highly effective
• doesn’t interfere with sex
• contraceptive effects reversible upon stopping
• periods regular, lighter and less painful
• reduced risk of ovarian, endometrial, colorectal cancer
• reduced ovarian cysts, benign breast disease, acne
• may protect against pelvic inflammatory disease

Disadvantages

• must be taken daily
• risk of STIs
• VTE, stroke, IHD risk
• breast, cervical cancer risk
• headaches, nausea, breast tenderness