Menopause

Question 1

what is the climacteric

Answer 1

another name for menopause

Question 2

what is the menopause

Answer 2

Last ever period a women will have- retrospective diagnostic after a year period free

Question 3

what is perimenopausal

Answer 3

when a women in going through the menopause

Question 4

what is the average age of menopause

Answer 4

51

Question 5

when is early, preamture and late menopause

Answer 5

Early menopause <45yrs
Premature menopause <40yrs
Late menopause >54yrs

Question 6

what can cause early menopause

Answer 6

natural

iatrogenic- oophyrectomy, chemo

Question 7

how is premature menopause diagnosed

Answer 7

vaso motor symptoms, pattern of periods and hormonal blood tests

Question 8

what cells secrete oestrogen

Answer 8

granulosa

Question 9

what are the effects of oestrogen

Answer 9

Secondary sexual characteristics
Hair distribution, body shape & fat distribution
Effect on collagen
Bone growth
Proliferates endometrium- causing periods

(menopausal loose oestrogen so the reversal of all of these occurs)

Question 10

when is FSH and LH raised

Answer 10

Raised just prior to ovulation
Raised with stopping Combined oral contraceptive pill or depoprovera
Raised with breastfeeding or certain medication (SSRI)

Question 11

why does a single raised FSH/ LH level not confirm menopause

Answer 11

as released in pulsatile fashion

do two blood tests 6 weeks apart

Question 12

if a women is >45 with symptoms of menopause and irregular periods do you need to test for menopause to diagnose

Answer 12

no- unless she has had hysterectomy then exclude cancer

Question 13

what are the physical symptoms of the menopause

Answer 13

Hot flushes
Night sweats
Palpitations
Insomnia
Joint aches
Headaches

Question 14

how long do hot flushes last

Answer 14

3-5 mins each for average 2yrs

10% for 15yrs

Question 15

how does social adversity affect symptoms

Answer 15

are compounded by stress and happiness

Question 16

what are the psychological symptoms of menopause

Answer 16

Mood swings
Irritability
Anxiety
Difficulty concentrating
Forgetfulness

Question 17

what are the sexual symptoms of menopause

Answer 17

Vaginal dryness (loss of collages in vaginal tissue)
Loss of libido (stress, loss of testosterone)

Question 18

what are the later symptoms of the menopause

Answer 18

urinary symptoms:
Frequency
Recurrent UTIs
Dysuria
Incontinence

Dry hair & skin
Atrophy of breast and genitals- change in fat distribution

Question 19

what are the features of Perimenopausal Dysfunctional Uterine Bleeding

Answer 19

Irregular periods
Inter-menstrual bleeding (Sporadic oestrogen production- endometrium thickens but don’t have regular hormones for ovulation)
Post menopausal bleeding

Question 20

what do you have to rule out with Perimenopausal Dysfunctional Uterine Bleeding

Answer 20

endometrial cancer

Question 21

what is the conservative management for menopause symptoms

Answer 21

Diet
Weight loss
Exercise
Lifestyle
Caffeine
CBT
Mindfulness

not licensed- Dietary supplements that contain plant oestrogens- e.g. soy

Question 22

what is the treatment for menorrhagia in menopuase

Answer 22

Mefenamic acid (NSAID that affects the prostaglandins in the uterus, reduced blood flow)
Tranexamic acid (stop body from breaking down clots)
Progesterones (pop, depot)
Intra-uterine system- mirena
Endometrial ablation
Hysterectomy- last resort

Question 23

what hormone replacement options are available for menopause

Answer 23

general rule: Topical HRT only +/- mirena for the shortest amount of time before the age of 60

Oestrogen alone (risk of cancer and VTE)
Oestogen and progesterone (reduced risk
Topical or oral
Give sequential HRT with progesterone towards end on cycle to have bleed
If want bleed free give continuously (only for women who have had a year of amenorrhoea)

Question 24

why might HRT be given after a hysterectomy

Answer 24

ablation to see if any endometrial tissue left, if some left will bleed

Question 25

when during menopause is HRT safe to give

Answer 25

within 10 years of it beginning

Question 26

what are the CI to HRT

Answer 26

Breast cancer
Undiagnosed abnormal vaginal bleeding
Endometrial cancer
Pregnancy
Active thrombo-embolic disorder
Recent Myocardial infarction
Active liver disease with abnormal LFT
Porphyria cutanea tarda

Question 27

what are the benefits of HRT

Answer 27

Symptom control
Quality of life
Reduced Osteoporotic fracture
Reduced Bowel cancer
Possibly protective Alzheimer’s & Parkinson’s diseases
HRT <10years after menopause fewer risks and less cardiovascular events

No increase cardiac risk if started before age 60
HRT with oestrogen alone is associated with no, or reduced, risk of coronary heart disease
HRT with oestrogen and progestogen is associated with little or no increase in the risk of coronary heart disease

Question 28

what are the risks of HRT

Answer 28

VTE (2-7 extra /1000)
CVA
Breast cancer (6 extra /1000)
Gallbladder disease
HRT >20 years after the menopause greater risk of harm

E2 no increased risk Br can
E & prog slight increased risk but stops with stopping

Question 29

does oral or transdermal HRT have higher risk of VTE

Answer 29

oral

Question 30

what greatly increases risk of breast Cx with HRT

Answer 30

obesity

Question 31

what are the non HRT options for menopause Tx

Answer 31

Clonidine (originally an anti hypertensive, affects temp regulation in hypothalamus, not as effective as HRT)
SSRIs (for mood)
vaginal lubricants: Regelle, Yes, Sylk