Menopause

Question 1

Diet and Lifestyle in Menoapuse

Answer 1

Stop smoking
Reduce alcohol
Normal BMI
Alternative treatments not evidence based

Question 2

Hormone replacement therapy options

Answer 2

Oestrogen alone
Oestrogen + Progestogen
Oral, Transdermal, Vaginal

Question 3

Oestrogen alone HRT

Answer 3

Elleste Solo
ONLY for women w/ hysterectomy
if BMI >30 give as TD patch not oral

Question 4

Oestrogen w/Progestogen HRT

Answer 4

Elleste Duet
Progestofen needed to protect endomet.
Cyclical or Continuous

Question 5

Cyclical Oestrogen w/Progestogen HRT

Answer 5

Monthly: Oest. daily and prog. for last 14d
3 Monthly: Oest. daily for 3 mo. + prog. for last 14d
Withdrawal bleed occurs on progesterone

Question 6

HRT suitable for perimenopause?

Answer 6

Cyclical O+P

Question 7

Continuous O+P HRT

Answer 7

always on O+P

only suitable if definitely post menopause

Question 8

Benefits of HRT

Answer 8

Improved vasomotor, sleep, performance
Prevention of osteoporosis
Improved GUT symptoms (dryness, dyspareunia)

Question 9

Risks of HRT

Answer 9

ALL ARE SMALL
Breast ca. and less extent endom. if no progestogen
CVD in older women

Question 10

Side effects of HRT

Answer 10

Oestrogen: breast tenderness, nausea, headache
Progestogen: fluid retention, mood swing, depression

Question 11

CI of HRY

Answer 11

Pregnancy
Breast + Endometrial Ca
Uncontrolled htn
Current VTE
Current thrombophilia

Question 12

Non-hormonal Mx of Menopause

Answer 12

Alpha agonist (clonidine)
Beta blocker (propranolol)
SSRI (fluoxetine) - vasomotor esp.
Symptomatic: lubricants, bisphosphonates

Question 13

Premature Ovarian Insufficiency Ix

Answer 13

LH, FSH, Oestrogen, testosterone, TFT, AFC, AMH

Diagonstic: 2xFSH >30 (4-6wks apart)

Question 14

POI Fertility?

Answer 14

Possible with IVF using donor or your own frozen eggs

Surrogacy/Adoption

Question 15

POI Considerations

Answer 15

Require HRT to avoid CVD and osteoporosis

- Regular DEXA

Question 16

PACES Counselling Menopause

Answer 16

Sx: Vasomotor, cognitive, sexual
Lifestyle: diet, smoking
Medical: HRT/SSRI, lubricant
- side effects
Contraception:
- >1yr amenorrhoeic if >50
- >2 yrs if <50