menopause

Question 1

define menopause

Answer 1

cessation of menstrual cycle for at least 12 months in a 45-55y female OR post hystertectomy

Question 2

median age for menopaude

Answer 2

51

Question 3

define perimenopause

Answer 3

1-11 months of amenorrhea in 45-55 with vasomotor symptoms

Question 4

define early menopause

Answer 4

cessation of menstrual cycle at 40-44y

Question 5

define pre mature ovarian insufficiency

Answer 5

under 40

Menopause-associated symptoms, including no or infrequent periods of more than 4 months duration

and

Elevated FSH levels (more than 30 IU/L) on 2 blood samples taken 4–6 weeks apart.

Question 6

risk factors for pre mature ovarian insufficiency

Answer 6

cancer, infection, chemotherapy , PCOS, thyroid problems, FHx (fragile X carrier)

Question 7

treatment for pre mature ovarian insuffiency

Answer 7

HRT until at least 51

Question 8

causes of menopause

Answer 8

• idiopathic
• PCOS
• ED
• hysterectomy
• sheehan + ashermann

Question 9

what is sheeehan

Answer 9

massive pituitary haemhorrage
typically after childbirtih so no hormones for periodd

Question 10

what is ashermanns

Answer 10

scar tissue in uterus post uterine surgery casues adhesions so hormones dont act properly

Question 11

sx of menopause

Answer 11

vasomotor sx:
flushing and night sweats

other sx:
brain fog
fatigue
mood swings
low libido and atrophic vaginitis
increase urination
bloating

Question 12

what is atrophic vaginitis

Answer 12

a condition where the vaginal walls become thin, dry, and inflamed due to decreased estrogen levels.

Question 13

sx of atrophic vaginitis

Answer 13

Itching
Dryness
Dyspareunia (discomfort or pain during sex)
Bleeding due to localised inflammation

Question 14

what does exam of vagina with atrophic vaginitis show

Answer 14

Pale mucosa
Thin skin
Reduced skin folds
Erythema and inflammation
Dryness
Sparse pubic hair

Question 15

tx of atrophic vaginitis

Answer 15

• Vaginal lubricants Eg replens
• Topical oestrogen

Question 16

how to diagnose menopause

Answer 16

clinicaly
amenorrhea for at leas 12m

Question 17

what to do if un certain when diagnosing menopause

Answer 17

do FSH
(>30 on 2 samples 4-6 weeks apart)

Question 18

tx of unprobelmatic menorpause

Answer 18

dont treat

Question 19

tx of problematic menopause

Answer 19

HRT

Question 20

what HRT to give for menopause

Answer 20

oestrogen and progesterone transdermal continous combined HRT

if post hysterectomy –> oestrogen ONLY

Question 21

what to do if HRT contraindicated in menopause px

Answer 21

give SNRI
eg venlafaxine

Question 22

why do u give HRT transdermally and not oral

Answer 22

to lower VTE risk

Question 23

how to take HRT if are perimenopausal

Answer 23

cyclically to mimic period

Question 24

how to take HRT if u are menopausal

Answer 24

continously

Question 25

pros of HRT

Answer 25

1. lower risk of bowel +endo+ ovarian cancer 2. increase QOL 3. lower risk of osteoporossi

Question 26

cons of HRT

Answer 26

1. increase breast ca risk if u take for more than 5y 2. increase VTE risk 3. increase stroke risk

Question 27

mc cause of post menopausal bleeding

Answer 27

atrpphic vaginitis

Question 28

most serious cause of post menopausal bleeding

Answer 28

endoemtrial cancer

Question 29

mc cause of post coital bleeding in young people

Answer 29

cervical ectropion

Question 30

mc cause of post coital bleeding in old people

Answer 30

atrophic vaginitis

Question 31

other causes of post menopausal bleeding

Answer 31

endometrial polyps endometiral atrophy

Question 32

what is dysparaneunia

Answer 32

painful sex

Question 33

2 types of dysparanenunia

Answer 33

superficial deep

Question 34

desrbe superficial dysparanenuia

Answer 34

pain on contact eg penis toucdhing vagina

Question 35

causes of superficial dysparanenunia

Answer 35

- vulvodynia - vulval cancer - lichen schlerosis - atrophic vaginitis

Question 36

describe deep dysparaneunia

Answer 36

pain on penetratio n

Question 37

causes of deep dysparanenunia

Answer 37

- endometriosis - adenmyosis - PID - cervical cancer