Menopause

Question 1

What is menopause?

Answer 1

Last menstrual period, retrospective diagnosis given after one year of amenorrhoea
High FSH >30
Low oestradiol <203
Aged 54 >80% of women thought to be postmenopausal

Question 2

What causes menopause?

Answer 2

As number of oocytes decreases, the reduction then in oestrogen leads to no ovulation; therefore the FSH increases due to lack of inhibitory feedback from low oestrogen on hypothalamus.

This leads to anovulatory cycles, menstrual irregularities

Question 3

What are the symptoms of menopause?

Answer 3

Hot flush/night sweat
Headaches
Palpitations
Leg cramps
urogenital symptoms
reduced libido
mood changes

Question 4

What are the long term consequences of menopause

Answer 4

Osteoporosis - oestrogens are important for maintenance of bone mass, acting to supress bone resorption by osteoclasts and to promote bone formation by osteoblasts.

CVD
Vaginal dryness and atrophy
Alzheimers

Question 5

How does oestrogen affect the bones?

Answer 5

Oestrogens are important for maintenance of bone mass, acting to supress bone resorption by osteoclasts and to promote bone formatino by osteoblasts.

Question 6

What are the treatment options for menopause?

Answer 6

Oestrogen - reverses symptoms of low oestrogen
Progesterone - protects endometrium keeps it thin.
Testosterone - increases energy levels and enhances sexual desire

Question 7

What are the benefits/risk of hormone replacement therapy in treating menopause?

Answer 7

Benefits:
Alleviates symptoms
protects bone
reduces incidence of colorectal cancer

Risks:
VTE
Breast cancer
Endometrial cancer

Question 8

What are the diagnostic criteria for premature ovarian insufficiency

Answer 8

Amenorrheoa 4 months
FSH>30 on two occasion 6 weeks apart
Women less than 40