Menstruation and Menopause

Question 1

What is the average age a woman in the UK goes though menopause?

Answer 1

51 years old

Question 2

What is the definition of menopause?

Answer 2

Cessation of menses for at least 12 consecutive months

Question 3

In a perimenopausal woman, when is contraception no longer required?

Answer 3

• 12 months after the last period in women > 50 years

- 24 months after the last period in women < 50 years

Question 4

What are the symptoms of menopause? How can they be classified?

Answer 4

1) Vasomotor symptoms, e.g. hot flushes, night sweats
2) Menstrual disturbance, e.g. irregular bleeding
3) Urogenital change, e.g. vaginal dryness/atrophy
4) Psychological, e.g. irritability, anxiety, depression

Question 5

What are the options for managing menopausal symptoms?

Answer 5

1. Conservative (i.e. lifestyle) measures, e.g. exercise, weight loss
2. HRT
3. Non-HRT e.g. SSRI (fluoxetine)

Question 6

Give two contraindications to prescribing HRT

Answer 6

• Current or past breast cancer

- Undiagnosed vaginal bleeding

Question 7

What is the definition of premature ovarian failure?

Answer 7

The onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years

Question 8

Are there any risk factors for premature ovarian failure?

Answer 8

• Family history

- Exposure to chemo/radiotherapy

Question 9

1) What is the first-line treatment for menorrhagia?

2) If the patient is trying to conceive, what would now be the first line management for menorrhagia?

Answer 9

1) IUS (Mirena coil)

2) Tranexamic acid

Question 10

What are the first and second line treatment options for primary dysmenorrhoea?

Answer 10

1) NSAID, e.g. ibuprofen, mefenamic acid

2) COCP

Question 11

What are the risks of HRT?

Answer 11

Increased risk of:

• VTE/stroke
• CVD
• Breast cancer
• Ovarian cancer

Question 12

What are the two categories of amenorrhoea?

Answer 12

Primary and secondary

Question 13

What is the definition of primary amenorrhoea?

Answer 13

Not starting menstruation by:

• 13 years if no other signs of puberty
• 15 years if other signs of puberty present (e.g. breast development)

Question 14

Give some causes of primary amenorrhoea

Answer 14

1. Functional hypothalamic dysfunction i.e. excessive exercise/weight loss
2. Genetic causes e.g. Turner’s, CAH, androgen insensitivity
3. Structural e.g. imperforate hymen

Question 15

What is the definition of secondary amenorrhoea?

Answer 15

Cessation of menses for:

• 3-6 months in women with previous regular menses
• 6-12 months in women with previous oligomenorrhoea

Question 16

Give some causes of secondary amenorrhoea

Answer 16

1. Physiological, e.g. pregnancy, menopause
2. Iatrogenic, e.g. contraception
3. Functional hypothalamic dysfunction, i.e. excessive exercise/weight loss
4. Ovarian disorders, e.g. PCOS, POF
5. Endocrine, e.g. thyrotoxicosis
6. Structural, e.g. Asherman’s

Question 17

When investigating the cause of amenorrhoea, gonadotrophins are measured…

Low gonadotrophins suggest…?
High gonadotrophins suggest…?

Answer 17

Low gonadotrophins suggest hypothalamic cause

High gonadotrophins suggest ovarian cause