Menopause and secondary amenorrhoea

Question 1

What is the menopause?

Answer 1

A woman’s last ever period

Question 2

What is the average age for menopause?

Answer 2

51

Question 3

What is premature menopause?

Answer 3

40 years or less

Question 4

What are some hormonal changes brought on by menopause?

Answer 4

Oestradiol falls
FSH rises
Still some oestriol from conversion of adrenal androgens in adipose tissue

Question 5

What are some common symptoms of menopause?

Answer 5

Hot flushes
Night sweats
Vaginal dryness
Low libido
Muscle and joint aches
Mood changes
Poor memory

Question 6

What are the effects of osteoporosis present in menopause?

Answer 6

Reduced bone mass
Bone density = T score
Risk of hip or vertebral fractures

Question 7

What are some risk factors associated with osteoporosis in menopause?

Answer 7

Low BMI
Caucasian
Smoking
High FSH
VitD/Calcium malabsorption
Oral corticosteroids
Hyperthyroid

Question 8

How is osteoporosis managed in menopause?

Answer 8

Weight bearing exercise
Calcium and VitD
Bisphosphonates
Denosumab

Question 9

What is an advantage of local vaginal HRT (oestrogen pessary/ring/cream)?

Answer 9

Minimal systemic absorption

Question 10

What is a drawback of local vaginal HRT (oestrogen pessary/ring/cream)?

Answer 10

Need to use long term to maintain benefit

Question 11

What are some advantages of transdermal systemic oestrogen for HRT?

Answer 11

Avoids first pass metabolism
less risk of VTE
Prevents endometrial hyperplasia from unopposed oestrogen

Question 12

What are some contraindications to systemic HRT?

Answer 12

Current hormone dependent cancer of breast/endometrium
Active liver disease
Uninvestigated abnormal bleeding

Question 13

What kinds of antidepressants should be avoided in the symptomatic treatment of menopause?

Answer 13

SSRI
SNRI
E.g. venlaflaxine

Question 14

What is an SERM?

Answer 14

Selective Estrogen Receptor Modulator
E.g. Tibolone
Used to treat menopause symptoms

Question 15

What are some non-medical ways to treat menopause symptoms?

Answer 15

Hypnotherapy
Exercise
Cognitive Behavioural Therapy
Non-hormonal lubricants for vaginal dryness

Question 16

How might menopause induced osteoporosis be treated?

Answer 16

Bisphosphonates (Etidronate, alendronate)

HRT

Question 17

What are some risks of HRT?

Answer 17

Breast cancer if combined
Ovarian cancer
VTE if oral

Question 18

How do bisphosphonates work?

Answer 18

Decrease osteoclast mediated bone resorption

Question 19

What is andropause?

Answer 19

Testosterone falls by 1% every year after 30

Question 20

Does andropause affect fertility?

Answer 20

No

Question 21

What is secondary amenorrhoea?

Answer 21

Has had periods in past but none for 6 months

Question 22

How is premature ovarian insufficiency managed?

Answer 22

Offer HRT until 50
Emotional support
Daisy network

Question 23

How is polycystic ovary syndrome diagnosed?

Answer 23

2 of the following
Olig0/amenorrhoea
Androgenic symptoms
Polycystic ovarian morphology on scan

Question 24

How does polycystic ovarian syndrome affect hormones?

Answer 24

Normal/high oestrogen
Increased androgens
Possible insulin resistance

Question 25

Are polycystic ovaries painful?

Answer 25

No

Question 26

Can adolescents get polycystic ovaries?

Answer 26

Yes
Common
Not associated with PCOS

Question 27

What is the management of PCOS?

Answer 27

Weight loss
GTT
Support and info
Antiandrogen
Spironolactone

Question 28

How should you investigate post-menopausal bleeding?

Answer 28

Trans-vaginal USS to look at endometrial thickness
Endometrial biopsy
Hysteroscopy