Menopause - Physiology, Symptoms and HRT

Question 1

What is the menopause?

Answer 1

-A woman’s ‘last spontaneous menstrual period’
=Average age is 51 years
=Normal range 45-55 years

Question 2

What two key events occur in the menopause?

Answer 2

-Loss of fertility
=Quality and quantity of oocytes
-Loss of ovarian hormonal function
=Oestrogen and Progesterone

Question 3

What are the names for early menopause?

Answer 3

-Early Menopause < 45 years
-Premature Menopause < 40 years
=Premature Ovarian Insufficiency (POI)

Question 4

What are the causes of premature menopause?

Answer 4

• IDIOPATHIC (89%) - autoimmune (Addison’s, thyroid insufficiency) - surgery / chemo or radiotherapy
• chromosomal (Turner’s, Fragile X) - infections - metabolic

Question 5

What medications are given in premature menopause?

Answer 5

Oestrogen replacement

Question 6

Describe the biochemical profile of post-menopausal women

Answer 6

-Oestradiol low
-FSH high (critical in diagnosis)
-LH raised
=may be many years of fluctuating levels in perimenopause
=most women don’t need hormone tests

Question 7

What are the predictors of menopause?

Answer 7

• FSH – day 3 raised level
• AMH – anti-Mullerian hormone: declines with age and useful marker of ovarian reserve (used in IVF not NHS and as for below)
• Inhibin B - declines with age and protein hormone marker of ovarian reserve
• Ovarian antral follicle count by ultrasound

Question 8

What are the vasomotor symptoms of menopause?

Answer 8

• Hot flushes (thermoregulatory function in hypothalamus- rise in skin temp by 5 degrees) and night sweats
• Palpitations, faintness
• Experienced by >80% of women
• Debilitating, embarrassing and unpleasant
• Severe sleep deprivation

Question 9

What are the other symptoms of menopause?

Answer 9

• Low mood
• Poor memory and concentration
• Mood swings
• Lack of confidence
• Low self-esteem
• Panic attacks
• Tiredness
• Low energy
• Joint pains
• Skin/hair changes

Question 10

What other life factors co-inside with menopause?

Answer 10

• Difficult teenage children / - empty nest syndrome
• Marital problems
• Frail elderly parents / parents-in-law
• Unsatisfying and low paid employment
• Effects of ageing on body - obesity, poor body image, low self-esteem

Question 11

Describe urogenital ageing

Answer 11

• Vaginal dryness and dyspareunia (pain during sex)
• Bladder neck symptoms: urgency, urge incontinence, Nocturia, recurrent urinary infections
• 30% of women admit that their UG symptoms strongly affect their daily lives
• Embarrassment inhibits most women from seeking help

Question 12

How does menopause affect sexual function?

Answer 12

• Affects state of relationship
• Lower sexual desire/ libido
• Orgasmic problems
• Pain
• Lack of testosterone?= replacement can help mood, libido and energy

Question 13

How is menopause linked to osteoporosis?

Answer 13

-Oestrogen physiological regulator of bone metabolism
=women have thinner bones
=lose bone density in menopause
=wedge fractures, risk of falling
-Long-term HRT prevents osteoporosis

Question 14

Describe HRT

Answer 14

-Hormone replacement therapy
=Oestrogen
=Progesterone (for endometrial protection)
=Testosterone
-oral, skin (transdermal) patches and gels, subdermal implant, intra-uterine progestogen
-Prescribed for menopausal symptoms

Question 15

What are the benefits of HRT?

Answer 15

• Improve quality of life: =relieve vasomotor symptoms -=lift depressed mood =improve vaginal symptoms
• Protection against osteoporosis (provided HRT is taken for long enough)
• Protection against bowel cancer

Question 16

What are the risks of HRT?

Answer 16

• Side effects: =bleeding problems, =bloatedness, =breast pain, ??
• Small extra risk of breast cancer with prolonged duration of use
• Increased risk of venous thromboembolism: x2 fold increase (tablets, not skin patches)
• Small excess risk of stroke