Menopause

Question 1

definition of menopause?

Answer 1

ceasing of menstruation

Question 2

average age of menopause?

Answer 2

51

Question 3

early menopause?

Answer 3

<45 years

Question 4

premature menopause?

Answer 4

<40 yrs

Question 5

late menopause?

Answer 5

> 54 yrs

Question 6

physiology of menopause?

Answer 6

1 million ova present at birth within the follicles
decrease over life so less eggs and less oestrogen produced from the granulosa cells of the follicles
FSH and LH continue to be produced from anterior pituitary and increase due to feedback system once oestrogen decreases

Question 7

5 effects of oestrogen?

Answer 7

secondary sexual characteristics
hair distribution, body shape and fat distribution
effect on collagen 
bone growth
proliferates endometrium

Question 8

how is menopause diagnosed?

Answer 8

largely a clinical diagnosis
vasomotor symptoms
pattern of periods
blood tests may be used but not really diagnostic (high FSH and LH can be due to lots of things and doesnt confirm menopause)

Question 9

when will FSH and LH be raised?

Answer 9

released in pulsatile fashion
raised prior to ovulation
rasied with stopping COCP or depoprovera
raised with breastfeeding or certain medications (SSRIs)

Question 10

why is menopause difficult to confirm in women who have had a hysterecromy?

Answer 10

they dont get any change in bleeding pattern

Question 11

physical symptoms of menopause?

Answer 11

hot flushes
night sweats
plapitations
insomnia
joint aches
headaches

Question 12

average duration of hot flushes?

Answer 12

on average last around 2 years

each flush lasts around 3-5 mins

Question 13

what can cause women to have more severe menopausal symtoms?

Answer 13

evidence suggests that women that are happier in life have less severe symptoms

Question 14

psychological symptoms of menopause?

Answer 14

mood swings
irritability
anxiety
difficulty concentrating 
forgetfulness

Question 15

what can contribute to psychological symptoms in women?

Answer 15

menopause occurs at time where there is often a lot of life stress
- children moving out, elderly parents, work responsibility etc

Question 16

sexual symptoms of menopause?

Answer 16

vaginal dryness (due to collagen loss)
loss of libido

Question 17

later symptoms in menopause?

Answer 17

recurrent UTIs (due to collagen loss)
dysuria
incontinence 
dry skin and hair
atrophy of breast and genitals

Question 18

describe perimenopausal dysfunctional uterine bleeding

Answer 18

irregular periods
inter-menstrual bleeding
post menopausal bleeding

Question 19

conservative management in menopause?

Answer 19

diet
weight loss
exercise
lifestyle
caffeine
CBT
mindfulness

Question 20

medical management of menorrhagia?

Answer 20

mefenamic acid (NSAID)
tranexamic acid (amino acid derivative which prevents breakdown of clots)
progesterones (POP, depot, IUD etc)
endometrial ablation
hysterectomy

Question 21

how is hormone replacement therapy (HRT) given?

Answer 21

oestrogen and progesterone (oestrogen alone can increase endometrial cancer risk)
can be topical or oral
can have combined continuous therapy so there is no time off or bleeding if patient prefers or theres a history of endometriosis or partial hysterectomy

Question 22

risks of HRT?

Answer 22

might have slight increase in VTE, heart disease, gallbladder disease and breast cancer risk but deemed safe within 10 years of menopause

Question 23

contra-indications for HRT?

Answer 23

breast cancer
undiagnosed abnormal vaginal bleeding
endometrial cancer
pregnancy
active thrombo-embolic disease
recent MI
active liver disease with abnormal LFTs
porphyria cutanea tarda

Question 24

benefits of HRT?

Answer 24

symptom control
QoL
reduced osteoporotic fractures
reduced bowel cancer risk
may protect against alzheimers and parkinsons
HRT <10 yrs after menopause has fewer risks and less cardio events

Question 25

non HRT medical management of menopause?

Answer 25

clomidine (alpha gaonist hypotensive)
SSRIs
regelle (vaginal moisturiser)
Yes
sylk (vaginal lubricant)