The Menopause and Postreproductive Health

Question 1

What causes menopause?

Answer 1

Due to the depletion of follicles to respond to FSH and thus lower levels of oestrogen.

Question 2

Define perimenopause

Answer 2

The period from the onset of the symptoms till the completion of menopause 12 months after last period

Question 3

Causes of postmenopausal bleeding

Answer 3

malignancy; endometrial/cervical must be ruled out (inc’ premalignant hyperplasia)

OR

‘Atrophic vaginitis’ - a poorly osteogrenized vaginal wall

Question 4

How to treat atrophic vaginitis therefore?

Answer 4

With topical oestrogen or oral ospemifene (a selective estrogen receptor modulator (SERM))

Question 5

What may be an unalarming cause of PMB?

Answer 5

If on HRT then may have bleeds from 14 days oestrogen / 14 days progesterone, mimicking the normal cycle.

Question 6

Investigation for PMB & when to biopsy?

Answer 6

Examination: Speculum & bimanual. TVS (can measure endometrium or polyps etc)

If endometrium shows >4mm thickening or there’s been multiple episodes of PMB

Question 7

Name some consequences of the menopause

Answer 7

• Drop in oestrogen results in higher blood pressure, and oestrogen usually prevents bad cholesterol, thus resulting in worse cholesterol levels.
• Drop in oestrogen; or is it the uncontrolled increase of oestrogen results in low levels of vit D causing osteoporosis on the bones.
• Hot flushes & night sweats / vasomotor
• Genitourinary syndrome of menopause
• Sexual problems

Question 8

With HRT when do we give combination? What are we giving on its own?

Answer 8

If they have a uterus then need to give it combined with progesterone for endometrial protection from unopposed oestrogen

Question 9

What does HRT increase the risk of?

Answer 9

Breast cancer (only if combined) & Endometrial (if oestrogen only)