Menopause

Question 1

Define Menopause

Answer 1

when menstruation stops permanently due to the loss of ovarian follicular activity - Dx 12 months of consecutive amenorrhoea

Question 2

Averge menopausal age in the UK

Answer 2

51

Question 3

Define Perimenopause

Answer 3

is the period before the menopause when the endocrinological, biological, and clinical features of approaching menopause start

Question 4

Perimenopause Sx

Answer 4

irregular cycles of ovulation and menstruation and ends 12 months after the last menstrual period

Question 5

Define Postmenopause

Answer 5

the time after a woman has not had a menstrual period for 12 consecutive months

Question 6

Define Early menopause

Answer 6

the cessation of ovarian function occurring between the ages of 40 and 45 years, in the absence of other causes of secondary amenorrhoea

Question 7

Define Premature menopause

Answer 7

definitive loss of ovarian function before the age of 40 years

Question 8

Menopause Ix

Answer 8

Hormonal screening
- Oestrogen
- Progesterone
- LH
- FSH

Question 9

Menopause hormonal screening findings

Answer 9

• LOW oestrogen + porgesterone
• High LH + FSH

No -ve feedback from oestrogen

Question 10

Perimenopausal Symptoms

Answer 10

Hot flushes
Emotional lability or low mood
Premenstrual syndrome
Irregular periods
Joint pains
Heavier or lighter periods
Vaginal dryness and atrophy
Reduced libido

Question 11

Menopause complications

Answer 11

• Osteoporosis
• Cardiovascular disease

Question 12

When is FSH testing indicated in menapause

Answer 12

1. < 40 years w/ meanopausal Sx
2. 40-50 years w/ Irregular cycles with vasomotor symptoms

Question 13

2 types of cyclical HRT

Answer 13

• Monthly HRT daily oestrogen + progesterone for the last 14 days of MC
• 3 monthly HRT daily oestrogen + progesterone for 14 days

Question 14

Women with a uterus HRT option

Answer 14

combined HRT (progesterone & oestrogen)

Question 14

Women without a uterus HRT option

Answer 14

oestrogen only

Question 14

Oral HRT Risks

Answer 14

• increase VTEs
• increases chance of a stroke

Question 15

Perimenopausal HRT option

Answer 15

Cyclical combined (daily oestrogen +14D progesterone) HRT

Question 16

Post-Menopausal HRT option

Answer 16

Continuous combined (progesterone+oestrogen) HRT

Question 17

Urogenital menopausal only Sx Tx

Answer 17

Vaginal moisturiser and lubricants

Question 18

Menopause diagnostic criteria

Answer 18

1. 12 consecutive months of amenorrhea (no periods) in women not using hormonal contraception
2. Symptomatic diagnosis in women without a uterus

Question 19

HRT contraindications

Answer 19

• Hormone-dependent breast, endometrial, or ovarian cancers
• Undiagnosed bleeding
• Active VTE/arterial disease
• Liver disease
• BMI > 30
• Migraine w/ aura
• Uncontrolled HTN

Question 20

HRT indications

Answer 20

• Menopausal vasomotor Sx: hot flushes, night sweats
• irregular periods

Question 21

HRT assoc. risks

Answer 21

• Breast ca.
• VTEs
• Stroke
• Ovarian ca.
• Endometrial ca.
• CVD

Question 22

HRT option for VTEs/stroke (e.g. BMI >30) risk women

Answer 22

Transdermal HRT

Question 23

Contraception advice for menopausal women

Answer 23

1. Age < 50 - needs contraception for **24 months** 2. Age > 50 needs contraception for **12 months** 3. COCP should be **STOPPED** in women at the age of 50