Menopause & premature ovarian insufficiency

Question 1

What are the phases of the ovarian cycle

Answer 1

-Follicular phase
-Ovulation
-Luteal phase
‘FOL’

Question 2

What are the phases of the uterine cycle

Answer 2

-Menstuation
-Proliferative
-Secretory
‘MPS’

Question 3

What are the differences between men and women in age related decline in gonadal function?

Answer 3

• Men don’t experience gametic exhaustion nor a sudden fall off in fertility, unlike women
• However they both experience senescent chanhges

Question 4

What is menopause

Answer 4

• The last menstrual period
• retrospective diagnosis after one year of amenorrhea
• FSH high>30
• estradiol low <203
• most women expected to be post menopausal at age 54

Question 5

What is the climateric?

Answer 5

• The period of time around the last menstrual period
• Also known as the perimenopause
• Based on symptoms
• vasomotor symptoms (night sweats, hot flushes) & irregular breathing

Question 6

How and when do you diagnose menopause

Answer 6

• If the women is >45 yrs, you can diagnose it with no lab tests( e.g FSH& AMH)
• perimenopause: vasomotor symptoms& irregular bleeding
• menopause: amenorrhea for >12 months in women with a uterus
• menopause: based on symptoms on women without a uterus

-Can be more difficult to diagnose in women taking hormone medications to control heavy bleeding (e.g COCP & high doses of progesterone)

Question 7

What happens in menopause?

Answer 7

• oocytes decrease, decreased estrogen (no ovulation)

- FSH increases (lack of inhibitory feedback from oestrogen on hypothalamus)

Question 8

What consequences does menopause cause?

Answer 8

• Anovulatory cycles, menstrual irregularities, menorrhagia
• physical changes
• psychological changes

Question 9

What are the long term consequences of menopause?

Answer 9

• osteoporosis as oestrogens are needed for the maintenance of bone mass in both males and females ,acting to suppress bone resorption by osteoclasts and to promote bone formation by osteoblasts
• CVD( coronary artery disease, stroke, venous thromboembolism, pulmonary embolism)
• vaginal dryness and atrophy
• alzheimers

Question 10

What different hormonal treatment options are available for menopause?

Answer 10

• Oestrogen: reverse symptoms and effects of low oestrogen
• Progesterone: Necessary to protect the endometrium if uterus present
• Testosterone: increases overall energy level, enhances sexual desire and arousal
• Continuous vs sequential

Question 11

What different non- hormonal treatment options are available for menopause?

Answer 11

• lifestyle measures
• replens
• Alpha 2 agonists: clonidine
• SSRI’S
• Gabapentin

Question 12

What are the benefits of using HRT to treat menopause?

Answer 12

• Alleviate symptoms
• Protect bones
• Protect CVD
• reduces incidence of colorectal cancer
• improve QOL

Question 13

What are the risks of using HRT to treat menopause?

Answer 13

• VTE

- breast and endometrial cancer

Question 14

What different HRT preparations are available for menopause

Answer 14

• Oral
• Transdermal
• Implant
• Local

Question 15

What is premature ovarian insufficiency?

Answer 15

• aka premature menopause or premature ovarian failure
• Diagnosis: amenorrhoea 4 months, FSH> 30U/L on two occasions 6 weeks apart, women less than 40yrs
• less common the younger you are
• In the case of idiopathic POI investigate via: cytogenetics, FMR1 premutation screening, anti-adrenal & anti-thyroid antibodies

Question 16

What different treatment options are available for POI

Answer 16

• Hormone replacement (HRT or COCP/patch)
• Fertility treatment
• Psychological support

Question 17

What leads to POI

Answer 17

• Inadequate oogenesis
• follicle depletion
• Follicle dysfunction