menopause management

Question 1

What lifestyle changes are recommended during menopause?

Answer 1

Stop smoking, reduce alcohol and caffeine consumption, weight loss, stress reduction, regular exercise. Alternative treatments like acupuncture, hypnosis, herbal remedies, phytoestrogens lack scientific basis.

Question 2

What are the key points about Oestrogen-only HRT?

Answer 2

Oestrogens Alone - Only suitable for women who have had a hysterectomy. Brand: Elleste Solo. If BMI > 30, oestrogen only HRT should be given as a transdermal patch rather than oral.

Question 3

What are the key points about Oestrogen with Progestogen HRT?

Answer 3

Oestrogen with Progestogen - Progestogen necessary to protect the endometrium. Brand: Elleste Duet. Cyclical: Monthly: oestrogen every day + progesterone for the last 14 days, Three Monthly: oestrogen every day for 3 months + progesterone for the last 14 days. Continuous: Suitable if definitely post-menopausal, take oestrogen & progesterone daily. LNG-IUS can act as prosgestogen component.

Question 4

What are the routes of administration for HRT?

Answer 4

Oral, Transdermal, Vaginal creams/gels (if predominantly vaginal symptoms).

Question 5

What are the benefits of HRT?

Answer 5

Improved vasomotor symptoms, sleep, and performance. Prevention of osteoporosis. Improved genital tract symptoms (dryness, dyspareunia).

Question 6

What are the risks and side-effects of HRT?

Answer 6

Risks: Breast cancer, Cardiovascular disease (in older women), VTE. Side-Effects: Oestrogenic: breast tenderness, nausea, headaches. Progestogenic: fluid retention, mood swings, depression.

Question 7

What are the contraindications for HRT?

Answer 7

Absolute: pregnancy, breast cancer (current or past), endometrial cancer, uncontrolled hypertension, current VTE, current thrombophilia, undiagnosed vaginal bleeding, severe liver disease.

Question 8

What are some non-hormonal treatments for menopause?

Answer 8

Alpha agonists (e.g., clonidine), Beta-blockers (e.g., propranolol), SSRIs (e.g., fluoxetine) + CBT – particularly effective for vasomotor symptoms. Symptomatic: lubricants, osteoporosis treatments (e.g., bisphosphonates).

Question 9

How should menopause be managed?

Answer 9

Lifestyle: Regular exercise, weight loss, reduce stress, sleep hygiene. HRT: Contraindications: current or past breast cancer, undiagnosed vaginal bleeding, untreated endometrial hyperplasia. No Uterus: oestrogen-only (give as patch if BMI>30). Uterus: should be given with progesterone component (e.g. Mirena). Risks: VTE, stroke, coronary heart disease, breast and ovarian cancer. Non-HRT: Vasomotor: fluoxetine, citalopram, venlafaxine. Vaginal dryness: lubricant. Psychological: self-help, CBT, SSRIs. Urogenital: topical oestrogens, lubricants.

Question 10

What should be explained to patients about menopause?

Answer 10

Changes that typically occur at menopause (hot flushes, sexual dysfunction, mood changes). Explain lifestyle factors (healthy diet, weight loss, smoking cessation). Explain medical options (HRT, SSRIs, topical lubricants/oestrogens). Tailor to needs of the patient. Explain risks/side-effects. Explain need for contraception. Advice on bone health, keeping up to date with national screening (breast and cervical), contraception, support groups. Role of MDT – GP, psychosexual counselling, gynaecology.

Question 11

What should be explained about contraception during menopause?

Answer 11

Until > 1 year amenorrhoeic if > 50 yrs. Until > 2 years amenorrhoeic if < 50 yrs.