CLIMACTERIC AND MENOPAUSE

Question 1

CLIMACTERIC – transition from
____________ to ______________ state

—

Answer 1

reproductive to non-reproductive

Question 2

MENOPAUSE – _____________________
of _____________ . Usually diagnosed
after ________ of _____________.

Answer 2

permanent ceasation

menstruation

1 year; amenorrhoea

Question 3

— The average age at menopause in
Nigeria is ______ ± 1.5 years.

— In western women, the average age at menopause is ______ years.
—

Answer 3

49

52

Question 4

Menopause occuring before the age of 45 is termed “ ____________________________”
.

Answer 4

PREMATURE MENOPAUSE

Question 5

PATHOPHYSIOLOGY of menopause

— Human ovary contains an outer ————- and an inner ___________ .
—
Both contains ___________ cells which provide support for the ovary, produce steroids (basically
___________) and some are recruited to become ___________ cells that surround ___________ in the cortex.
—
For every ___________ which matures to ovulation, up to _________m follicles fail and become ___________ while probably only about 400 out of the 400,000 follicles present at puberty mature to ovulation

Answer 5

Cortex ; medulla.

stroma ; androgens

theca ; follicles

follicle ; 1000 follicles

atretic

Question 6

PATHOPHYSIOLOGY of menopause

— With ageing, the ___________ diminishes and finally the ___________ fail.
—
The first endocrine change as menopause approaches is a fall in the ___________ level. The function of this hormone is to _________________ . Hence FSH level ________ .
—Oestradiol level subsequently _________ and become insufficient to bring about endometrial ___________ and menstruation

Answer 6

follicle count ; ovaries

inhibin ; inhibit FSH production.

rises ; falls

proliferation

Question 7

The first endocrine change as menopause approaches is a fall in the ___________ level.

Answer 7

Inhibin

Question 8

PATHOPHYSIOLOGY of menopause

— The ovaries produce four principal
hormones: __________ , __________
and the __________ (__________
and __________). It also
secretes the peptide hormone
“__________”
—

Answer 8

oestradiol ; progesterone

androgens ; testosterone

androstenedione ; Inhibin
—

Question 9

Ovarian cycle and menstrual
function are controlled by _______ and ______ release

Answer 9

FSH

LH

Question 10

PATHOPHYSIOLOGY
— In premenopausal state, majority of the circulating plasma oestradiol is produced by the __________ cells lining the developing __________, by conversion of __________
and __________, and catalysed by the
__________ enzyme, stimulated by ________.
—
Oestradiol is also converted in the ________ cells from androgens, which are produce from __________ under stimulation of ________.

Answer 10

granulosa ; follicles

androstenedione ; testosterone,

aromatase ; FSH.
—
theca ; cholesterol

LH.

Question 11

NON-PHYSIOLOGICAL CAUSES
OF MENOPAUSE
—Primary causes – may be due to
chromosomal abnormalities
such as variants of ________________ and autoimmune disorders such as
________________, ________________
disease.

Answer 11

turner’s syndrome

hypothyroidism

Addison’s disease.

Question 12

NON-PHYSIOLOGICAL CAUSES
OF MENOPAUSE
— Secondary causes – can follow
surgeries such as _____________
with _____________ for malignancies or severe endometriosis, radiotherapy, chemotherapy, use of drugs such _____________ in treating conditions like uterine fibroids and
endometriosis, and infections such
as tuberculosis, mumps.

Answer 12

hysterectomy ; bilateral salpingo-
oophorectomy

GnRH analogues

Question 13

EFFECTS OF MENOPAUSE

VASOMOTOR SYMPTOMS

List 3

Answer 13

—Hot flushes.
—Night sweats.
—Palpitations.

Question 14

EFFECTS OF MENOPAUSE

UROGENITAL
—
Vulval and vaginal ————- .
— Recurrent ___________ .
— Sensory urgency.
— Urogenital ___________ .
—______________.
— Decreased _______________.

Answer 14

dryness

urinary tract infections

prolapse; Dyspareunia

sexual desire

Question 15

EFFECTS OF MENOPAUSE
MUSCULOSKELETAL
—
___________ .
—___________ with resultant pathological fractures

Answer 15

Arthritis

Osteoporosis

Question 16

EFFECTS OF MENOPAUSE
PSYCHOSEXUAL
—
Insomnia.
— Anxiety.
—_____________.
— Forgetfulness (__________).
—_____________ .
— Difficulty in concentration.
— Decreased sexual desire.

Answer 16

Low esteem

Dementia

Depression

Question 17

EFFECTS OF MENOPAUSE
CARDIOVASCULAR
— Cardiovascular diseases such as
__________________.

Answer 17

cardiac ischaemia

Question 18

EFFECTS OF MENOPAUSE

OTHERS
— Skin ____________, dryness and itchiness.
—________ changes.

Answer 18

wrinkling

Hair

Question 19

CLINICAL EVALUATION OF A
PERIMENOPAUSAL OR POST-
MENOPAUSAL WOMAN
HISTORY
— Age
—__________ of amenorrhoea.
— Enquire about menopausal symptoms, their _________,________, and __________ on day-to-day activities.
— Previous __________ and __________.
— Personal and family history to assess the risk for cardiovascular disease, thrombosis, osteoporosis, breast cancer and ovarian

Answer 19

Duration ; frequency

severity ; impact

treatments ; side effects

Question 20

CLINICAL EVALUATION OF A
PERIMENOPAUSAL OR POST-
MENOPAUSAL WOMAN
EXAMINATION
— Assessment of cardiovascular system
– PR, BP, heart sounds.
— Check for ______________________.
— Pelvic examination – check for vulva
and vaginal ____________ changes.

Answer 20

thyroid enlargement

atrophic

Question 21

CLINICAL EVALUATION OF A
PERIMENOPAUSAL OR POST-
MENOPAUSAL WOMAN
INVESTIGATIONS
—________ >30IU/L is diagnostic.
— Investigations to rule out secondary
causes e.g._______ to rule out
___________ , 24-hour urinary
______________ level (VMA) to rule out _______________

Answer 21

FSH

TFT; hypothyroidism

catecholamine; phaechromocytoma

Question 22

MANAGEMENT
—
Alternative therapy – use of _____________ , herbal preparations like _______________ , acupuncture,
magnetism, reflexology.

Answer 22

phyto-oestrogens

St. John’s Wort

Question 23

MANAGEMENT
Medical treatments –
NON-HORMONAL
1. α-adrenergic e.g. clonodine.
2. β-blockers e.g. propanolol.
3. Selective serotonin reuptake inhibitors (SSRI) e.g.
venlafaxine, fluoxetine, Gabapentin.
4. Selective Estrogen Receptor Modulator (SERM)
e.g. Raloxifene.
5.Tibolone – has oestrogenic, progesteronic and androgenic properties. If given for 1 year, will
effectively reduce climacteric symptoms and reduce bone loss.

Answer 23

Cute

Question 24

MANAGEMENT
Medical treatments –
HORMONAL
1. HRT – can be ___________________ ,
___________________, ___________________. This
helps in reducing ____________.

Answer 24

oestrogen alone

oestrogen + progesterone combined

progesterone alone

hot flushes.

Question 25

Contraindications to use of HRT —__________ — __________ cancer — __________ cancer — Acute liver disease — Uncontrolled ____________ —________________ — Thrombophilia — Abnormal ___________ — Large ___________ — Migraine with ________

Answer 25

Pregnancy; Breast; Endometrial hypertension; Venous thromboembolism uterine bleeding ; uterine fibroids Aura

Question 26

Side effects of HRT —_____________ — Nausea — Headaches — Breast ______________/_____________ — Leg cramps — Dyspepsia —__________ ___________ , depression, irritability —_________ — Constipation — _______eased appetite

Answer 26

Fluid retention enlargement ; tenderness Acne; — Mood swings; Bloating Increased

Question 27

Benefits of HRT —Relief of vasomotor symptoms. —Relief of urogenital symptoms. —Improvement in osteoporosis. —reduce risk of __________. Reduce risk of ____________.

Answer 27

Stroke Colon cancer