Menopause & Reproductive Health

Question 1

Post-Menopausal Bleeding

Answer 1

Definition: vaginal bleeding occurring >12 months after last menstrual period

Causes
PMB is endometrial cancer until proven otherwise

Endometrial cancer
Endometrial hyperplasia +/- atypia and polyps

Cervical carcinoma
Cervicitis
Cervical polyps

Ovarian carcinoma

Atrophic vaginitis

Investigations & Examinations
Bimanual & speculum
Cervical smear

TVUS
Endometrial thickness
<=4mm is normal

Management
Single exposed of VB and normal endometrial thickness –> no need for biopsy

Multiple bleeds or thickened endometrium —> endometrial biopsy +/- hysteroscopy

Question 2

Post-Menopausal Osteoporosis

Answer 2

Compromised bone strength/density predisposing to risk of fractures

WHO definition: BMD >2.5 SD below young adult score (T score

Question 3

Symptoms and Complications of the Menopause

Answer 3

Vasomotor
Hot flushes
Night sweats
Usually present for less than 5 years

Urogenital
Oestrogen def --> vaginal atrophy
Dyspareunia
Itching
Burning
Dryness
Urinary symptoms (freq, urg, nocturia, incontinence, recurrent infection)

Sexual
50% affected
Decrease interest
FSD: female sexual dysfunction 
Loss of sexual desire
Loss of sexual arousal
Problems with orgasm
Dyspareunia

CVS
1/3 death in all women