The Menopause

Question 1

What is the definition of the menopause?

Answer 1

Permanent cessation of menstruation due to loss of ovarian follicular activity, 12 months since final menstrual period.

Median age= 51 years old

Question 2

What is perimenopause?

Answer 2

Period of time from the beginning on menopausal symptoms to 12 months after last menstrual period. Usually starts in 40s.

Question 3

Give 3 symptoms of perimenopause

Answer 3

Weight gain in lower abdomen, buttocks and thighs
Varying menstrual cycle length
Hot flushes + night sweats

Question 4

Describe the physiological changes that occur in the menopause

Answer 4

Abscense of follicular development 
Extreme reduction in oestrogen levels --> ovary stops producing oestrogen 
FSH= increased by 10-20 fold 
LH= increases by 3 fold 
Androgens= increases

Question 5

Give 5 symptoms of the menopause

Answer 5

Depression 
Headaches
Fatigue
Hot flushes
Loss of libido 
Increased cardiovascular risk 
Osteoporosis- bony fractures 
Genital and urinary tract atrophy- dyspareunia, itching, burning, dryness

Question 6

What is the definition of early menopause?

Answer 6

Menopause before the age of 40. Affects 1% of women

Question 7

Give 3 causes of early menopause

Answer 7

Premature ovarian failure (Turner’s, autoimmune, TB, malaria)
Radio/chemotherapy
Surgical- bilateral oophorectomy

Question 8

Give 3 benefits of HRT medication

Answer 8

Cures hot flushes
Increases libido
Decreases risk of osteoporotic fractures
Decreases risk of colorectal cancers

Question 9

Give 3 risks of HRT medication

Answer 9

Increases risk of breast cancer
Increased risk of endometrial cancer
Increased risk of VTE
Increased risk of gallbladder disease

Question 10

Give 4 side effects of HRT

Answer 10

Nausea
Headaches
Breast tenderness
Indigestion 
Abdominal pain 
Vaginal bleeding

Question 11

Give 4 contraindications for starting HRT

Answer 11

Hx of breast, ovarian or endometrial cancer
Hx of thromboembolism 
Hypertension 
Liver disease
Pregnant

Question 12

What type of HRT should be given to women post-hysterectomy?

Answer 12

Oestrogen only HRT

Question 13

What type of HRT should be given to women with a uterus?

Answer 13

Combined oestrogen and progesterone

Progesterone protects against uterine cancers

Question 14

What type of HRT should be given to women with vaginal atrophy?

Answer 14

Topical oestrogens

Question 15

Give 4 potential alternatives to HRT

Answer 15

Lifestyle changes (exercise regularly, eat healthily, stop smoking, cut down on coffee and alcohol)
Clonidine (alpha-adrenoreceptor agonist)
Tibolone (synthetic HRT)
Herbal remedies
Prevention of osteoporosis (Ca2+, vitamin D, bisphosphonates)

Question 16

What is the definition of postmenopausal bleeding?

Answer 16

Vaginal bleeding over 12 months after last menstrual bleed

Question 17

Give 5 causes of postmenopausal bleeding

Answer 17

Endometrial cancers
Cervical cancers
Endometrial hyperplasia 
Atrophic vaginitis 
Cervicitis
Cervical polpys

Question 18

How is postmenopausal bleeding investigated?

Answer 18

Bimanual and speculum examination
Cervical smear
Transvaginal USS
Endometrial biopsy and hysteroscopy

Question 19

How is postmenopausal bleeding managed?

Answer 19

Treat obvious cause
Rule out malignancy
If atrophic vaginitis- topical oestrogens