Menopause

Question 1

What is menopause

Answer 1

Permenant cessation of menstruation due to loss of follicular activity

Question 3

How is menopause usually diagnosed

Answer 3

Restrospective diagnosis after no periods for 12 months

Question 4

What is the period called with irregular periods and vasomotor symptoms?

Answer 4

Perimenopause

Question 5

What vasomotor symptoms can occur?

Answer 5

Hot flushes

night sweats

Question 6

What sexual dysfunction can occur during menopause

Answer 6

Vaginal dryness
Reduced libido
Orgasm problems
Dyspareunia

Question 7

What psychological problems can occur during menopause?

Answer 7

Depression
Anxiety
Mood swings
Lethargy
Reduced concentration

Question 8

When is FSH assessed for in a menopausal picture?

Answer 8

FSH if a women is under 40

or

women ages 40-45 with symptoms or a change in their cycle

Question 9

What are the timeframe in which the women will require contraception?

Answer 9

Two years after last menstrual period if under 50

One year after last menstrual period if over 50

Question 10

What medications can be given for menopausal vasomotor symptoms?

Answer 10

HRT
Tibolone (synthethic steroid hrt)
Clonidine (adrenergic receptor agonist)

CBT
SSRIs (flux)
Topical T
Vaginal oestrogen creams
vaginal moisturisers e.g. replens

Question 11

Breast cancer risk with which hrt?

Answer 11

COMBINED hrts

Question 12

coronary heart disease risk with which hrt?

Answer 12

Combined hrt

Question 13

venous thromboembolism risks with which hrt?

Answer 13

oral hrt (use transdermal instead)

Question 14

stroke risk with which hrt?

Answer 14

oral oestrogen

Question 15

Ovarian cancer risk with which hrt?

Answer 15

All HRTs

Question 16

Which condition is associated with POI?

Answer 16

Addisons disease

Question 17

Hormone profile in menopause?

Answer 17

Low estrogen and progesterone

high LH and FSH

Question 20

Long term risks due to lack of oestrogen?

Answer 20

CVD / Stroke

Oesteoporosis

Pelvic organ prolapse

Urinary incontinence

Question 21

How to manage:

Mild hot flushes without sleep and mood disturbance

Answer 21

lifestyle changes, with review of symptoms if they worse

• consider HRT or SSRI after

Question 22

When do you give oestrogen alone HRT?

Answer 22

When there is NO uterus (progesterone is given to protect the endometrium)

Question 23

How does BMI affect Estrogen only HRT?

Answer 23

Give as a transdermal patch if BMI is over 30 Important as transdermal doesnt increase VTE risk

Question 24

Cyclical vs continuous combined HRT?

Answer 24

Cyclical : if permenopausal to allow withdrawal bleed Continuous: if deffo post-menopausal

Question 25

Described cyclical HRT?

Answer 25

Cyclical → if perimenopausal. Withdrawal bleed occurs when on progesterone. Monthly (oestrogen every day of month + progesterone for last 14 days - if regular menses) or three monthly (oestrogen every day for 3 months + progesterone for last 14 days - if irregular menses)

Question 26

What increases risk of breast cancer estrogen or progesterone?

Answer 26

Progesterone

Question 27

Contraindications to HRT?

Answer 27

current or past breast cancer endometrial cancer uncontrolled hypertension current VTE Current thrombophilia