Menopause

Question 1

Phases of menopause

Answer 1

1. Premeno - 5yrs before last period
2. Perimeno- start of symptoms
3. Meno- last period
4. Postmeno - after 1yr of last period

Occurs: 45-55yrs
>50yrs - 1yr amenorrhoea
<50yrs - 2yrs amenorrhoea

Question 2

When/which investigation for menopause

Answer 2

FSH- >30 elevated (LH also elevated)
Estrogen, progesterone decreased

Done in:
1. <45yrs
2. Hysterectomy
3. IUD amenorrhoea

Question 3

HRT increases and decreases risk of which conditions

Answer 3

Given only in Severe vasomotor symptoms
↑Risk of: (>5yrs use, less risk in <60yrs pts/within 10yrs of menopause )
1. Breast CA
2. Coronary artery disease
3. Pulm embolism

↓Risk of:
Bowel CA
Bone fractures

Breast CA - estrogen only HRT

Question 4

C/I of HRT

Answer 4

1. Breast CA
2. Endometrial CA
3. AUB

Relative:
1. CVS disease
2. Thromboembolic
3. Active liver disease
4. Migraine with aura

Question 5

HRT regimen in uterus + and -

Answer 5

Uterus present:
Estrogen (causes endometrial CA)
AND
progesterone (protective)

No uterus:
Estrogen HRT transdermal>oral
(transdermal - less risk of embolism)

Question 6

HRT regimen in perimenopausal

Answer 6

●Sequential/cyclical progesterone-
last 14days of cycle
●Continuous estrogen

Question 7

HRT regimen in postmenopausal

Answer 7

Continuous estrogen and progesterone

Question 8

Alternative rx to HRT

Answer 8

CHC upto 50-51yrs
HRT after 51yrs

Question 9

S/E of HRT

Answer 9

1. Heavy bleed - ↓Estrogen
2. Nausea/breast symp - ↓Estrogen
3. Unscheduled vaginal bleed - ↑prog

Question 10

*Duration of HRT use

Answer 10

1. > 5yrs - ↑r/f
2. But can be used long term
3. Annual check up mandatory

Question 11

Vaginal dryness mx

Answer 11

1. First line: non hormonal
   K-Y gel/Replens
2. Low dose estrogen cream/pessary

Question 12

Mx in symptomatic pts who have C/I for HRT

Answer 12

1. SSRI/SNRI
   Venlafaxine
   Paroxetine

Question 13

Premature ovarian failure

Answer 13

<40yrs menopause
Inv - FSH, oestradiol
Mx- HRT upto 51yrs