Menopause

Question 1

The usual age of menopause in the uk

Answer 1

51

Question 2

Define or describe menopause

Answer 2

It marks the end of reproductive years , usually between ages 45 and 55 after 12 months without menstruation

Question 3

State the stages of menopause

Answer 3

Périménopause with hormonal changes

Menopause

Post-menopause (with stabilised lower hormones )

Question 4

Is menopause a disease ?

Answer 4

No

Question 6

Aménorrhea

Answer 6

The absence of a menstrual period in a woman of reproductive age

Question 7

Premature and early menopause increases the risk of certain diseases/disorders , name some

Answer 7

C.V disease
Osteoporosis
Cognitive decline

Question 8

What are some symptoms that a women in perimenopause (35-45) may experience

Answer 8

*Irregular periods

Night sweats

Weight gain

Hot flashes

Loss of libido

Note that perimenopause usually lasts about 10 years on average

Question 9

What are some symptoms/complications that a women may experience post menopause

Answer 9

Vaginal Discomfort

Osteoporosis

Urinary infections

Heart disease

Question 10

What are some symptoms /complications a women may experience IN menopause (age 51 usually in the uk)

Answer 10

Vaginal discomfort

Breast cancer

Depression

Question 11

Describe early and premature menopause

Answer 11

Early occurs before age 45 and affects 5% of women

Premature occurs before 40 affects 1% of women

Question 12

Describe POI(primary ovarian insufficiency)

Answer 12

It involves intermittent ovarian function with occasional menstruation and fertility , differing from premature menopause where ovarian function usually stops completely

There is low oestrogen levels in POI

Question 13

Symptoms of early menopause

Answer 13

Irregular periods
Hot flushes
Night sweats
Vaginal dryness
Mood changes

Question 14

How do we diagnose early menopause

Answer 14

Using diagnostic blood tests , mainly measuring FSH levels twice over 4-6weeks to confirm menopause

We should rule out thyroid dysfunction by carrying out thyroid tests

Question 15

why is it important to diagnose early menopause early

Answer 15

cos early identification enables timely treatment to reduce long term risks and improve qol

Question 16

On which cells do LH act to produce androgens(oestrogen and testosterone) and progesterone(during the luteal phase) in the ovary

Answer 16

theca cells

Question 17

on which cells do FSH act to produce oestrogen, activin and inhibin

Answer 17

granulosa cells in the ovary

Question 18

function of activin and inhibin

Answer 18

activin activates gonadotropin secretion, which triggers a positive feedback( more oestrogen and activin being produced).

inhibin does the opposite, triggering a negative feedback

Question 19

what are gonadotropins

Answer 19

they are hormones, primarily FSH and LH that regulate the reproductive system by stimulating the gonads(testes and ovaries ) to mature and function.

Question 20

describe what happens to FSH and LH levels respectively from puberty to post-menopause(i.e puberty, adulthood, menopause, post menopause)

Answer 20

puberty onset; pituitary gland becomes more sensitive, FSH and LH levels start to rise and the meanstrual cycle begins

Reproductive Years;
LH and FSH follow a monthly cycle:
Early follicular phase: FSH rises slightly → recruits follicles.
Mid-cycle: Rising oestrogen from the dominant follicle triggers a positive feedback surge of LH (and smaller FSH rise) → ovulation.
Luteal phase: Progesterone and oestrogen from the corpus luteum inhibit GnRH → LH & FSH fall again.

perimenopause; As ovarian reserve declines, oestrogen and inhibin (which normally suppress FSH) fall.
The pituitary responds by producing more FSH (markedly elevated) and more LH (moderately elevated).
Cycles become irregular, ovulation less consistent.

post-menopause; Ovaries stop producing significant oestrogen or progesterone.

The loss of negative feedback on the hypothalamus/pituitary causes very high FSH and high LH levels — these remain elevated indefinitely.

No cyclical variation anymore (flat, persistently high gonadotropins)

Question 21

what hormonal changes occur during menopause

Answer 21

there is a decrease in ovarian follicles, consequently reducing oestrogen and inhibin, and increase FSH and LH secretion

NB; that the ovarian follicles are triggered to mature by FSH , which would usually cause an increase in oestrogen. but in menopase, there is not enough healthy follicles to be triggered, even w FSH levels high, hence the decrase in oestrogen levels

Question 22

the role of oestrogen

Answer 22

regulates mood, bone density, heart health and cognition

so it’s decline causes associated symptoms and health risks (like osteoporotic risk being increased)

Question 23

tthe impact of progesterone decline in menopause

Answer 23

contributes to menstrual iregularities and mood fluctuations during menopause

Question 24

common symptoms of menopause

Answer 24

Common Physical Symptoms;
Symptoms such as hot flashes, night sweats, vaginal dryness, and breast soreness frequently affect menopausal women.

Cognitive and Psychological Effects;
Mood changes, sleep disturbances, and brain fog

Question 25

what effect does the decline in oestrogen levels during menopause have on serotonin

Answer 25

it disrupts serotonin(lowers levels), causing mood swings and depression during menopause

Question 26

name some ways we can diagnose menopause

Answer 26

after 12months of amenorrhea, without other pathological causes in women over 45 with typical symptoms. FSH testing; levels above 30IU/L on two samples 4-6 weeks apart from each other confrim premature menopause or ovarian insufficiency AMH; Anti-mullerian hormone is associated with ovarian reserve. Decline with age -> undetectable at menopause

Question 27

which test is mainly carried out to rule out other conditions when diagnosing menopause

Answer 27

thyroid function tests, to exclude hyperthyroidism, which can mimic menopausal symptoms and affect the accuracy of diagnosis

Question 28

state some ways that we can treat/manage menopause

Answer 28

hormonal treatment options(using HRT and COCs to restore hormonal balances and reduce health risks ) lifestyle modifications(calcium rich die, weight bearing exercises, smoking cessation, alcohol moderation...etc) psycological support(NHS talking therapy...etc)

Question 29

what is the recommended first line pharmacological treatment for menopausal symptoms in women under 60 without contraindications

Answer 29

HRT

Question 30

types of HRT

Answer 30

combined HRT (includes oestrogen and progesterone) oesrogen-only HRT (usually for women post-hysterectomy) ## Footnote hyserectomy a surgical operation to remove the uterus (womb).

Question 31

in what dosage forms could HRTs be available

Answer 31

available in diverse forms such as tablets, patches, gels, sprays, implants, and intrauterine systems for tailored treatment.

Question 32

in women with low libido, what may be precribed if HRT proves insufficient in managing their symptoms

Answer 32

Testosterone

Question 33

what are some non-hormonal drugs that could be used in treating/managing menopause

Answer 33

SSRIs, SNRIs, gabapentin, CLONIDINE...etc ## Footnote not as effective as oestrogens or HRTs , even tho they may help ,manage symptoms

Question 34

some alternative therapies used in managing menopause

Answer 34

acupuncture self-hypnosis herbal remedies (note that these may not neccesarily be effective)

Question 35

what is the hormonal link btn menopause and osteoporosis

Answer 35

significant decline in oestrogen levels during menopause accelerates bone loss , esp in the first 5-10yrs post-menopause. women may lose up to 20% of their bone density in this period, therefore increase osteoporosis risk.

Question 36

what is the first line treatment in reducing bone loss in women under 60 without contraindications also what is the second line treatment

Answer 36

HRT (helps maintain oestrogen levels, reducing fracture risk) Denosumab NB; **these should be used alongside lifestyle modifications. also regular bone density (DEXA) scans recommended for women at risk** ## Footnote Denosumab treats osteoporosis by targeting a molecule called RANKL, which is crucial for the development and activity of bone-resorbing cells (osteoclasts). By blocking the RANKL-RANK interaction, denosumab inhibits osteoclast formation, function, and survival, which decreases bone breakdown (resorption) and increases bone mineral density and strength

Question 37

what are some UK organisations that provide support in menopause

Answer 37

British Menopause Society; BMS provides training and resources to healthcare professionals to improve menopause care across the UK. Women’s Health Concern; The patient arm of BMS offers independent advice and trustworthy menopause information for women. The Menopause Charity; This charity advocates for awareness and community engagement to improve menopause support. Menopause Support UK; Campaigns for enhanced menopause education and workplace policies to support affected individuals.

Question 38

what is the link between rapamycin and fertility

Answer 38

rapamycin is a drug that is under research, for it's suspected usefulness in extending female fertility by preserving ovarian reserve and delaying ovarian aging by up to five years. it does this by influencing the TOR((Target of Rapamycin)) pathway, which regulates cell survival and aging process