Menopause

Question 1

Define menopause

Answer 1

• Permanent cessation of menstruation for 12 consecutive months
• Due to ovarian failure
• Ovaries stop producing oestrogen, progesterone and viable eggs

Question 2

Average age and stages

Answer 2

• UK average ≈ 51 years
• Perimenopause: transition with fluctuating hormones
• Menopause: 12 months amenorrhoea
• Postmenopause: persistently low hormones and long‑term risks

Question 3

Premature ovarian insufficiency (POI)

Answer 3

• Menopause before age 40
• Requires specialist assessment

Question 4

Why menopause happens (HPO axis)

Answer 4

• Ovarian failure → ↓ oestrogen
• Loss of negative feedback
• Pituitary ↑ FSH markedly
• High FSH + low oestrogen = menopause

Question 5

Diagnosis in women >45

Answer 5

• Clinical diagnosis only
• Menopausal symptoms + 12 months amenorrhoea
• FSH testing NOT required

Question 6

Diagnosis age 40–45

Answer 6

• Symptoms plus consider FSH measurement

Question 7

Diagnosis <40 (POI criteria)

Answer 7

• ≥4 months amenorrhoea
• 2 FSH tests 4–6 weeks apart
• Refer to specialist

Question 8

FSH testing limitations

Answer 8

• Unreliable if on hormonal contraception or HRT

Question 9

Factors causing earlier menopause

Answer 9

• Smoking
• Low BMI
• Low socioeconomic status
• Early menarche

Question 10

Factors causing later menopause

Answer 10

• Family history
• Multiple pregnancies
• Oral contraceptive use
• Higher BMI

Question 11

Hormonal changes causing symptoms

Answer 11

• Progesterone falls first → insomnia, irritability
• Oestrogen fluctuates then declines

Question 12

Oestrogen receptor locations

Answer 12

• Brain
• Bone
• Skin
• Vagina and bladder
• Heart

Question 13

Vasomotor symptoms

Answer 13

• Hot flushes
• Night sweats
• Formication

Question 14

Genitourinary syndrome of menopause (GSM)

Answer 14

• Vaginal dryness
• Dyspareunia
• UTIs
• Incontinence
• Vaginal atrophy

Question 15

Physical and cognitive symptoms

Answer 15

• Central fat gain
• Joint aches
• Mood changes
• Brain fog

Question 16

Long‑term consequences

Answer 16

• Osteoporosis and fractures
• Cardiovascular disease risk

Question 17

Why hot flushes occur

Answer 17

• Oestrogen withdrawal alters hypothalamic temperature regulation
• Noradrenaline surge

Question 18

Hot flush triggers

Answer 18

• Smoking
• Alcohol
• Caffeine
• Spicy food
• Stress
• Obesity

Question 19

Non‑hormonal treatments

Answer 19

• Lifestyle changes
• CBT
• Limited evidence phytoestrogens

Question 20

Prescription non‑hormonal drugs

Answer 20

• SSRIs/SNRIs (e.g. venlafaxine)
• Clonidine
• Gabapentin
• Oxybutynin
• Fezolinetant

Question 21

Tibolone

Answer 21

• Synthetic steroid with oestrogenic, progestogenic and androgenic activity
• Improves flushes and libido
• Risks: stroke >60, cancer risk

Question 22

HRT indications

Answer 22

• Vasomotor symptoms
• Sleep and mood
• Vaginal atrophy

Question 23

Types of HRT

Answer 23

• Oestrogen‑only: no uterus
• Combined: uterus present

Question 24

Why progestogen is needed

Answer 24

• Prevents oestrogen‑induced endometrial proliferation
• Reduces cancer risk

Question 25

HRT regimens

Answer 25

- Perimenopause: cyclical - Postmenopause: continuous combined

Question 26

Topical vaginal oestrogen

Answer 26

- Used for local symptoms only - Minimal systemic risk

Question 27

Common HRT side effects

Answer 27

- Breast tenderness - Nausea - Headache - Fluid retention

Question 28

HRT risks

Answer 28

- VTE - Stroke - Breast cancer - Endometrial cancer - Ovarian cancer

Question 29

Oral vs transdermal oestrogen

Answer 29

- Oral increases clotting factors - Transdermal has lower VTE risk

Question 30

Absolute contraindications

Answer 30

- Breast cancer - Previous VTE - Endometrial cancer - Unexplained bleeding - Severe liver disease

Question 31

Relative contraindications

Answer 31

- Migraine - Fibroids - Controlled hypertension

Question 32

When to stop HRT immediately

Answer 32

- Chest pain - Breathlessness - Calf swelling - Neurological symptoms - Jaundice

Question 33

Monitoring and duration

Answer 33

- Review at 3 months then annually - Try stopping after 3–5 years

Question 34

Cancer logic

Answer 34

- Unopposed oestrogen → endometrial cancer

Question 35

Obesity and cancer risk

Answer 35

- Fat converts androgens to oestrogen - ↑ endometrial cancer risk

Question 36

Key exam answers

Answer 36

- >45: clinical diagnosis - Vaginal symptoms only: topical oestrogen - No uterus: oestrogen‑only HRT