Sexual Health - Menopause

Question 1

What is the menopause?

Answer 1

Retrospective diagnosis after a woman has had no periods for 12 months

Permanent end to menstruation

Question 2

When do most women experience the menopause?

Answer 2

51 years old

Question 3

What do these terms mean?
- Menopause
- Postmenopause
- Perimenopause
- Premature menopause

Answer 3

Menopause
Permanent end of menstruation after 12 months of amenorrhoea

Postmenopause
12 months after final menstrual period onwards

Perimenopause
Time around menopause where women can experience vasomotor symptoms and irregular periods
Includes time leading up to last menstrual period and 12 months after
45 years old

Premature menopause
Menopause before 40, result of premature ovarian insufficiency

Question 4

What causes the menopause?

Answer 4

Lack of ovarian follicular function

Oestrogen and progesterone are low

LH and FSH are high, no negative feedback

Question 5

What is the physiology of the menopause?

Answer 5

Decline of ovarian follicles

Without follicle growth, reduce oestrogen production

Decreased negative feedback
Increased LH and FSH

Failing follicular development causes anovulation

Lower levels of oestrogen cause perimenopausal symptoms

Question 6

What are perimenopausal symptoms?

Answer 6

Hot flushes
Low mood
Premenstrual syndrome
Irregular periods
Joint pains
Heavier or lighter periods
Vaginal dryness and atrophy
Reduced libido

Question 7

What does a lack of oestrogen increase the risk of developing?

Answer 7

CVD and stroke
Osteoporosis
Pelvic organ prolapse
Urinary incontinence

Question 8

How is perimenopause and menopause diagnosed?

Answer 8

Women over 45 years
Clinical diagnosis

FSH blood used to help in:
- Women under 40 suspected premature menopause
- Women aged 40-45 with menopausal symptoms or cycle changes

Question 9

How long do women still need to use contraception for after the menopause?

Answer 9

Over 50
1 year

Under 50
2 years

Question 10

How are perimenopausal symptoms managed?

Answer 10

Most likely to resolve after 2-5 years
- No treatment
- HRT
- Tibolone (acts as continuous combined HRT, only after 12 months of amenorrhoea)
- Clonidine
- CBT
- SSRI antidepressants, fluoxetine or citalopram
- Vaginal oestrogen (cream or tablets to help dryness)
- Vaginal moisturisers