9 - Menopause

Question 1

What is the definition of menopause?

Answer 1

- Permanent cessation of menstruation for 12 consecutive months

• When no primary follicles left so oestrogen levels deccline
• “monthly stop”

Question 2

What is the average age of menopause?

Answer 2

• 45-55 so 50
• Below 40 with abrupt cessation is usually pathological so needs to be investigated

Question 3

What are the stages of menopause?

Answer 3

• Pre-menopause
• Perimenopause
• Menopause
• Post-menopause

Question 4

What happens in pre and perimenopause?

Answer 4

- Pre: Initial changes in menstrual cycle, may be shorter or ovulation may be early or absent. Oestrogen falls so FSH and LH rise, FSH more, but cycle normal. Around 40 and reduced fertility

- Peri: Transition phase where physiological changes like hot flushes and mood swings so infrequency of menstruation

Question 5

What happens in menopause and post menopause?

Answer 5

- Menopause: Permanent cessation of menstruation for 12 months

- Post: After 12 months. No longer able to concieve like in pre and perimenopause

Question 6

What happens to the quality and quantity of oocytes as we age?

Answer 6

Both decline

Question 7

What happens to the levels of gonadotrophins during menopause?

Answer 7

• Oestrogen levels fall due to no follicles
• No inhibin either
• LH and FSH, especially FSH rise rspidly

Question 8

What hormone is used to diagnose menopause?

Answer 8

FSH

Question 9

What is responsible for all of the horrible symptoms of menopause?

Answer 9

• Mostly oestrogen deficiency
• Different symptoms in early, intermediate and late stages

Question 10

What are some symptoms that can occur in early stages of menopause?

Answer 10

• Hot flushes and sweating
• Insomnia
• Mood swings and depression
• Irregular menstruation

Question 11

What are some symptoms that can occur in the intermediate of menopause?

Answer 11

• Vaginal atrophy leading to dyspareunia
• More UTIs and stress incontinence
• Reduction of pubic hair due to lowered testosterone
• Loss of vaginal rugae
• Breast tissue reduce in size
• Loss of skin elasticity
• Changes to hair and voice
• Bloating and constipation as low motor activity

Question 12

If a postmenopausal woman presents with symptoms of vaginal bleeding, what should you investigate into?

Answer 12

• Endometrial carcinoma as no progesterone being produced so woman is subject to unopposed oestrogen

Question 13

If a woman of post-menopausal age presents to you with bloating, what diagnosis should you consider?

Answer 13

• Ovarian cancer
• Ask if they were on HRT as link between the two

Question 14

What are some disease processes that can occur in the post menopausal woman?

Answer 14

• Increased risk of osteoporosis, athersclerosis and Alzheimer’s disease.

Question 15

Why are post menopausal woman at risk of osteoporosis?

Answer 15

Oestrogen inhibits osteoclast activity so without it calcium loss from bone. Lose bone mass and bone height

Question 16

Why are post menopausal woman at risk of CVS disease?

Answer 16

• Low levels of oestrogen and progesterone change the lipid profiles
• Increases circulating lipid levels so at risk of atherosclerosis, MI and stroke

Question 17

What is a hot flush?

Answer 17

Question 18

What changes occur to the internal genitals during menopause?

Answer 18

• Ovaries shrink due to less oestrogen. Some aromatisation occurs to keep oestrogen level up

Question 19

What changes occur to the external genitals in menopause?

Answer 19

Question 20

What changes occur to the general appearance of a woman in menopause and her digestive/urinary system?

Answer 20

• Constipation due to reduced motor activity
• Thinner less elastic bladder and loss of pelvic tone so urinary incontinence
• UTIs

Question 21

How can doctors help woman to manage menopause?

Answer 21

Hormonal:

• HRT such as vaginal cream, patches or orally

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• Lifestyle advice such as exercise and low fat diet
• Dress in light layers, avoid caffiene and spicy foods

Question 22

What are the risks and benefits of HRT?

Answer 22

Benefits

• Can improve wellveing
• Can limit osteoporosis
• Endometrial cancer risk only in oestrogen-only HRT

Risks

• Ovarian and Breast cancer
• Not advised for cardioprotection
• Blood clots

Question 23

What effect does progesterone have on the endometrium?

Answer 23

When high it turns the glands from straight to coiled and they start secreting thick mucus

Question 24

What roles do oestrogen and progesterone have in the body, apart from its roles in the reproductive tract?

Answer 24

Question 25

What are some signs of Turner's syndrome and what health problems are they at risk of?

Answer 25

- Diabetes - Hypertension due to kidney and heart issues - Low IQ - Abnormal bone development - Thyroid issues (hypo)

Question 26

If a woman had primary amenorrhea and high FSH levels, what is the possible cause of the amenorrhea?

Answer 26

Ovarian agenesis as no oestrogen to have negative feedback on FSH

Question 27

What are some causes of menorrhagia?

Answer 27

- Endometriosis - Fibroids - Coagulation disorders - Drugs like warfarin