Menopause

Question 1

What is menopause?

Answer 1

Cessaton of menstruation defined as 12 months after final period.

Question 2

What is the aetiology of menopause?

Answer 2

Physiological: ovarian failure associated with dramateic decline in number of oocytes and reduciton in ovarian sensitivity to LH/FSH.

Iatrogenic: oopherectomy, radio or chemotherapy.

RF include high age, smoking, AI disorders, high altitude, chemotherapy, radio, surgery.

Average age 51.

Question 3

What would you find in the history of menopause?

Answer 3

Amenhorrea. Vasomotor symptoms (flushes, night sweats etc) urogenital symptoms (dry, dyspareunia, frequency, dysuria) psychological symptoms (low mood, lethargy, reduced libido).

Question 4

What would you find in the examination of menopause?

Answer 4

General: thin dry skin, breast atrophy.

Vaginal: atrophy, pelvic organ prolapse

Question 5

What is the pathology of menopause?

Answer 5

Decreased follicular activity -> reduced FSH/LH -> oestrogen and progesterone fall. Low OES leads to symptoms.

Question 6

What investigations would you do for menopause?

Answer 6

Blood (FSH high >30IU/L

Question 7

What is the management of menopause?

Answer 7

HRT: OES replacement to relieve vasomotor symptoms. Add progesterone unless hysterectomy. Tibolone is OES/PROG/ANDROG properties. May be given orally, transdermal, Vaginal , implants.

OTHER: SERMS, Ca supplements, bisphosphonates. Natural phytoestrogens are usually self prescribed but no evidence base. Vaginal lubrication.

Question 8

What are the complications of menopause?

Answer 8

Osteoporosis, CHD risk. Depression in the first postmenopausal time. May have increased irsk of Alzheimer’s.