Problems Around the Menopause

Question 1

what causes menopause?

Answer 1

due to a loss of ovarian follicular activity leading to a fall in oestrogen levels below that needed for endometrial stimulation

Question 2

premature menopause definition?

Answer 2

menopause <45

Question 3

how is premature menopause confirmed?

Answer 3

2 measurements of FSH and LH at least 2 weeks apart

Question 4

physical effects of meopause?

Answer 4

vasomotor (hot flushes)
joint aches and pains
dry and itchy skin
hair changes
vaginal dryness and soreness (dyspareunia)
recurrent UTI
urogenital prolapse
osteoporosis
cardiovascular disease
dementia

Question 5

psychological features of menopause?

Answer 5

labile mood
anxiety
tearfulness
loss of concentration
poor memory
loss of libido

Question 6

first step in management of menopause?

Answer 6

manage symptoms conservatively (lifestyle modification, increase exercise etc)

Question 7

what is the main medical management for troublesome menopause symptoms?

Answer 7

hormone replacement therapy

can be given via pathes, gels, tablets or implants

Question 8

what is the main hormone in HRT and how is it given?

Answer 8

oestrogen

can be given alone if the women has no uterus or in combination with progesterone in others

Question 9

best method of HRT in women with risk of VTE?

Answer 9

oestrogen patches

transdermal avoids first pass metabolism reducing impact on liver

Question 10

HRT can be given in what cycles?

Answer 10

continuous combined HRT (have to be post-menopausa)

cyclical combined HRT (for perimenopausal women who still get periods)

Question 11

how is cyclical combined HRT given?

Answer 11

oestrogen tablets each day of the month and a progesterone tablet on the last 14 days of the month

Question 12

side effects of continuous combined HRT?

Answer 12

can have erratic bleeding in first 3-6 months

Question 13

what 3rd hormone can be added to help reduced libido?

Answer 13

testosterone

Question 14

what non-hormonal treatment can be used for menopausal treatment?

Answer 14

SSRI

CBT can help manage psychological effects

Question 15

when might SSRI be used instead of HRT?

Answer 15

women with history of breast cancer

HRT much more effective

Question 16

how soon is improvement seen after starting HRT?

Answer 16

4-6 weeks

Question 17

when should women be reviewed after starting HRT?

Answer 17

3 months

Question 18

why do women with premature ovarian failure have to take HRT until age 50?

Answer 18

protect bone health

Question 19

how can cardio risk be reduced in premature menopause?

Answer 19

sex steroid hormone replacement

will also prevent osteoporosis and improve cognitive function

Question 20

contraception around the menopause?

Answer 20

contraception should continue for 2 years after the last menstrual period in women under 50
should continue for 1 year in women > 50

Question 21

side effects of HRT?

Answer 21

oestrogen related side effects (breast enlargement, leg cramps, dyspepsia, fluid retention, nausea, headaches)
progesterone related side effects (similar to pre-menstrual symptoms - fluid retention, breast tenderness, headaches, acne, mood swings, depression, irritability, constipation, increased appetite)

Question 22

risks associated with HRT?

Answer 22

breast cancer
VTE, PE and stroke
endometrial cancer

Question 23

risk of breast cancer in HRT?

Answer 23

only small increase

Question 24

risk of VTE in HRT?

Answer 24

risk doubles (esp in first year)
risk without HRT is low anyway so double risk still isnt that big
causes bigger risk in women with other risk factors too
lower risk than COCP

Question 25

how can risk of endometrial cancer be reduced in HRT?

Answer 25

adding progesterone

risk is higher if oestrogen only

Question 26

absolute contraindications to HRT?

Answer 26

suspected pregnancy
breast cancer
endometrial cancer
acute liver disease
uncontrolled hypertension
known VTE
known thrombophilia
osteosclerosis

Question 27

relative contraindications to HRT?

Answer 27

uninvestigated abnormal bleeding
large uterine fibroids
past history of benign breast disease
unconfirmed personal history or strong family history of VTE
chronic stable liver disease
migraine with aura