Session 10 - Menopause

Question 1

What is menopause?

Answer 1

Menopause is the permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity.

Question 2

What is menopause defined as?

Answer 2

Menopause is defined as the time when there has been no menstrual periods for 12 consecutive months and no other biological or physiological causes can be identified.

Question 3

What does the decline in ovarian function due to ageing lead to?

Answer 3

Infrequent ovulation, decreased menstrual function and eventually cessation of menopause.

Question 4

What are the four phases of menopause?

Answer 4

Pre-menopause
Peri-menopause
Menopause
Post menopause

Question 5

What is pre-menopause? What happens during this phase?

Answer 5

The time prior to menopause.

• changes in menstrual cycle start to occur (follicular phase shortens, ovulation early or absent)
• less oestrogen secreted
• LH and FSH levels rise, particularly FSH, because of reduced negative feedback
• reduced fertility

Question 6

What is peri-menopause? What happens during this phase?

Answer 6

The transition phase from reproductive life to menopause.

• characterised by physiological changes associated with the end of reproductive capacity
• terminates with the completion of menopause

Question 7

What is the post-menopausal stage?

Answer 7

It is defined as the time after which a woman has experienced 12 consecutive months of amenorrhoea

Question 8

What is the cause of menopause?

Answer 8

As women age, the ovaries become depleted of follicles and no amount of gonadotrophins will encourage them to work. This means that no more follicles develop so cessation of menstrual cycle occurs.

Question 9

Which hormone is measured to diagnose physiological menopause?

Answer 9

FSH

FSH levels will be high as during menopause oestrogen and inhibin production decline, meaning the negative feedback on FSH production is removed.

Question 10

What are the early consequences of oestrogen deficiency?

Answer 10

Hot flushes
Sweating
Insomnia
Menstrual irregularity
Psychological symptoms

Question 11

What are the intermediate consequences of oestrogen deficiency?

Answer 11

Vaginal atrophy
Dyspareunia (painful sexual intercourse)
Skin atrophy
Urge-stress incontinence

Question 12

What are the late consequences of oestrogen deficiency?

Answer 12

Osteoporosis
Atherosclerosis - coronary heart disease, cardiovascular disease
Alzheimer’s disease

Question 13

What are hot flushes?

Answer 13

Transient rises of skin temperature over face, chest, neck and head. Followed sometimes by refuse perspiration.

Question 14

What kinds of dysfunctional uterine bleeding can menopausal women experience?

Answer 14

Spotting between cycles
Extremely heavy bleeding
Mid-cycle bleeding
Longer, shorter or unpredictable lengths of time between periods
Longer, shorter or unpredictable lengths of periods

Question 15

What psychological changes are seen in menopause?

Answer 15

Frequent headache
Irritability 
Fatigue
Depression and insomnia
Diminished interest in sex (maybe due to emotional upset or secondary to painful intercourse due to dry vagina)

Question 16

What changes occur to the ovaries during menopause?

Answer 16

The ovaries become smaller (atrophy)

Question 17

What changes occur to general appearance during menopause?

Answer 17

Skin - losses elasticity, becomes thin. Due to loss of elastin and collagen.
Weight - increases, likely due to irregular eating habits due to mood swings. Fat deposited around hips, waist and buttocks.
Hair - becomes dry and coarse after menopause, maybe hair loss due to decreased oestrogen
Voice - deepens due to thickening of vocal cords

Question 18

What change are seen in the digestive system due to menopause?

Answer 18

Motor activity of the entire digestive tract is diminished after menopause. Results in constipation.

Question 19

What are the changes seen in the urinary system as a result of menopause?

Answer 19

Tissue lining the urethra and bladder becomes drier, thinner and less elastic (due to decreased oestrogen).
Loss of pelvic tone. 
Urinary incontinence.
Increased frequency .
Increased tendency to develop UTIs.

Question 20

What changes in the uterus occur due to the menopause?

Answer 20

Uterus becomes small and fibrotic due to atrophy of the muscles (shrinkage of myometrium and regression of endometrium).

Question 21

What changes to the cervix occur due to the menopause?

Answer 21

Cervix becomes smaller and appears to merge with the vagina.

In older women the cervix may be impossible to distinguish from the vagina due to:

• thinning of cervix
• loss of vaginal rugae

Question 22

What changes are seen in the vulva due to menopause?

Answer 22

The fat in the labia majora and the mons pubis decreases and pubic hair becomes sparse.

Question 23

What changes are seen in the breasts due to menopause?

Answer 23

In thin women the breasts become flat and shrivelled.

In heavy women the breasts remain flabby and pendulous.

Question 24

Why are post-menopausal women at increased risk of developing osteoporosis?

Answer 24

Reduced oestrogen means increased osteoclasts activity. Therefore greater breakdown of bone.

Question 25

What non-hormonal treatments can be used to alleviate the symptoms of menopause?

Answer 25

Dressing in light layers to alleviate hot flushes.
Avoid caffeine, alcohol and spicy foods.
Reduce dietary fat intake.
Regular exercise.

Question 26

What treatment can be used to treat the consequences of menopause?

Answer 26

Hormone replacement therapy (HRT)

Question 27

In what ways can HRT be administered?

Answer 27

In pill form
Vaginallly (as a cream)
Transdermally (in patch form)

Question 28

What are the possible disadvantages of HRT?

Answer 28

Increased risk of certain types of cancer.
Increased risk of blood clots.
Side effects, e.g. bloating, breast tenderness, nausea, leg cramps, vaginal bleeding, etc.