The Menopause

Question 1

What is the menopause?

Answer 1

When there has been no period for 12 months.
This occurs on average at age 52

Question 2

How do you diagnose menopause?

Answer 2

Clinically with history, age and symptoms.

If under age 45 then do FSH and consider genetic testing

Question 3

What are the menopause symptoms?

Answer 3

Vasomotor symptoms - hot flushes, night sweats.
Vulvo-vaginal dryness.
Sleep disturbance.
Mood disturbance - depression, irritability, anxiety, memory, alzheimers.
Sexual dysfunction
Urethral mucosa atrophy - frequency, dysuria, incontinence, recurrent UTIs

Question 4

What are the different types of HRT?

Answer 4

Can be given via tablets, patches or gels.
Oestrogen and progesterone given unless woman has had a hysterectomy or has Mirena coil.
Tibolone - contains oestrogens, progestogen and androgens.

Question 5

What are the risks of HRT?

Answer 5

Small increased risk of breast cancer using estrogen and progesterone but not with oestrogen alone.

Increased VTE risk with oral HRT but not transdermal.

Question 6

What are non HRT treatments for vasomotor symptoms?

Answer 6

Clonidine,
SSRIs,
Gabapentin

Question 7

What are the side effects of oestrogens?

Answer 7

Breast tenderness,
Leg cramps,
Bloating,
Nausea,
Headaches.

Question 8

What are the side effects of progestigens?

Answer 8

PMS symptoms,
Mood swings,
Breast tenderness,
Backache,
depression,
Pelvic pain,
Fluid retention,
Weight gain.

Question 9

What are the contraindications for HRT?

Answer 9

Undiagnosed PV bleeding,
Pregnancy,
Breastfeeding,
Breast cancer,
Acute liver disease,
HTN,
VTE,
Recurrent stroke.

Question 10

What are the investigations for menopause?

Answer 10

Pregnancy test.
FSH for woman < 40 years old. May be useful aged 40-45.