Menopause

Question 1

Define premature and early menopause.

Answer 1

• Premature menopause: <40 years
• Early menopause: <45 years

These definitions help categorize the onset of menopause.

Question 2

Name TWO risk factors for early menopause. (2)

Answer 2

• Smoking
• Chemotherapy or radiation
• Ovarian surgery

These factors can influence the timing of menopause.

Question 3

Name FOUR common symptoms of menopause. (4)

Answer 3

• Hot flashes (vasomotor symptoms)
• Vaginal dryness
• Sleep disturbance
• Mood changes
• Sexual dysfunction
• Urinary symptoms

These symptoms are frequently reported by menopausal women.

Question 4

Name THREE genitourinary symptoms of menopause. (3)

Answer 4

• Vaginal dryness
• Urinary urgency
• Dysuria
• Dyspareunia

These symptoms specifically affect the genitourinary system.

Question 5

Name THREE sexual symptoms associated with menopause. (3)

Answer 5

• Decreased libido
• Dyspareunia
• Vaginismus

These symptoms can impact sexual health during menopause.

Question 6

When should laboratory investigations be considered in suspected menopause?

Answer 6

• Atypical symptoms
• Symptoms occurring before age 45

These criteria help determine the need for further testing.

Question 7

Name THREE laboratory tests that may be ordered when investigating menopause. (3)

Answer 7

• FSH
• LH
• Estradiol
• TSH
• Prolactin
• β-hCG

These tests help assess hormonal levels related to menopause.

Question 8

Which hormone is the first to rise during menopause?

Answer 8

FSH

This rise in FSH is a key indicator of menopause.

Question 9

What estradiol level is consistent with menopause?

Answer 9

Estradiol <20 pg/mL

This level indicates a significant decline in estrogen production.

Question 10

Name FOUR lifestyle measures to help reduce vasomotor symptoms. (4)

Answer 10

• Exercise
• Reduce alcohol intake
• Dress in layers
• Avoid hot drinks
• Use fans or cooling strategies

These measures can alleviate discomfort associated with hot flashes.

Question 11

Name TWO criteria for using hormone therapy for vasomotor symptoms. (2)

Answer 11

• Age <60 years
• Within 10 years of menopause

These criteria help identify suitable candidates for hormone therapy.

Question 12

Name THREE absolute contraindications to menopausal hormone therapy. (3)

Answer 12

• Breast cancer
• History of VTE
• Coronary artery disease
• Stroke
• Liver disease
• Unexplained vaginal bleeding
• Pregnancy

These conditions prohibit the use of hormone therapy due to increased risks.

Question 13

Name THREE conditions that are relative (not absolute) contraindications to hormone therapy. (3)

Answer 13

• Smoking
• Diabetes
• Hypertension
• Migraine with aura

These conditions require careful consideration before prescribing hormone therapy.

Question 14

Why must progestin be added when prescribing estrogen to women with an intact uterus?

Answer 14

To reduce the risk of endometrial cancer

This is a critical safety measure in hormone therapy.

Question 15

Name ONE advantage of transdermal estrogen compared with oral estrogen.

Answer 15

• Lower risk of VTE
• Lower stroke risk
• No first-pass hepatic metabolism

These benefits make transdermal options preferable for some patients.

Question 16

Name THREE non-hormonal medications used for vasomotor symptoms. (3)

Answer 16

• Venlafaxine / desvenlafaxine
• Escitalopram
• Gabapentin
• Clonidine

These medications can provide relief without hormonal treatment.

Question 17

Which tool should be used to assess fracture risk in postmenopausal women <65 years?

Answer 17

FRAX score

The FRAX score helps evaluate the risk of fractures based on clinical factors.

Question 18

At what FRAX threshold should bone mineral density (BMD) testing be ordered?

Answer 18

>10% risk of major osteoporotic fracture

This threshold indicates the need for further evaluation of bone health.

Question 19

Name TWO indications for osteoporosis pharmacologic treatment in postmenopausal women. (2)

Answer 19

• Fragility fracture
• ≥10% major fracture risk
• >3% hip fracture risk

These indications guide treatment decisions for osteoporosis.

Question 20

Name TWO medications used to treat osteoporosis in postmenopausal women. (2)

Answer 20

• Bisphosphonates
• Denosumab

These medications are commonly prescribed for osteoporosis management.

Question 21

After how many years should a bisphosphonate drug holiday be considered in intermediate-risk patients?

Answer 21

5 years

This recommendation helps mitigate potential long-term side effects.

Question 22

What is the first-line treatment for vaginal dryness due to menopause?

Answer 22

Vaginal moisturizers

This treatment can provide immediate relief for vaginal dryness.

Question 23

Name TWO second-line treatments for vaginal atrophy. (2)

Answer 23

• Vaginal estrogen tablets
• Estrogen vaginal ring
• Topical estrogen cream

These treatments are effective for more severe cases of vaginal atrophy.

Question 24

Name THREE treatments for menopausal insomnia. (3)

Answer 24

• Sleep hygiene
• Treat vasomotor symptoms
• Cognitive behavioural therapy
• Exercise

These strategies can improve sleep quality during menopause.

Question 25

What is the main indication for **menopausal hormone therapy (HRT)**?

Answer 25

**Moderate to severe vasomotor symptoms (hot flashes, night sweats)** ## Footnote HRT is primarily used to alleviate these symptoms during menopause.

Question 26

Name **TWO principles** for prescribing menopausal hormone therapy. (2)

Answer 26

* Use the lowest effective estrogen dose * Reassess the need for therapy annually * Individualize therapy ## Footnote These principles help ensure safe and effective treatment.

Question 27

Which women can receive **estrogen-only hormone therapy**?

Answer 27

**Women who have had a hysterectomy** ## Footnote Estrogen-only therapy is appropriate since there is no risk of endometrial hyperplasia.

Question 28

What type of hormone therapy should women with an **intact uterus** receive?

Answer 28

**Estrogen + progestin therapy** ## Footnote This combination is necessary to protect the endometrium.

Question 29

Why must **progestin** be added to estrogen therapy in women with a uterus?

Answer 29

**To prevent endometrial hyperplasia and cancer** ## Footnote Progestin counteracts the effects of estrogen on the endometrium.

Question 30

Name **TWO ways** progesterone can be given with estrogen therapy. (2)

Answer 30

* Continuous daily progesterone * Cyclical progesterone (12–14 days per month) ## Footnote These methods help manage the effects of estrogen on the endometrium.

Question 31

What is a common consequence of **cyclical progesterone therapy**?

Answer 31

**Withdrawal bleeding** ## Footnote This occurs due to the cyclical nature of the therapy.

Question 32

Name **TWO advantages** of transdermal estrogen over oral estrogen. (2)

Answer 32

* Lower risk of VTE * Lower stroke risk * No first-pass hepatic metabolism * Fewer sexual side effects ## Footnote Transdermal delivery can be safer and more effective for some women.

Question 33

Name **ONE disadvantage** of transdermal estrogen therapy.

Answer 33

* Skin irritation * Higher cost ## Footnote These factors may affect patient compliance.

Question 34

Name **TWO examples** of oral estrogen formulations used for HRT. (2)

Answer 34

* Conjugated estrogen (Premarin) * Estradiol (Estrace) ## Footnote These are commonly prescribed oral forms of estrogen.

Question 35

Name **TWO progestin options** used in HRT. (2)

Answer 35

* Micronized progesterone (Prometrium) * Medroxyprogesterone * Norethindrone acetate ## Footnote These progestins are used to complement estrogen therapy.

Question 36

What is a **tissue selective estrogen complex (TSEC)**?

Answer 36

**Combination of estrogen with a SERM that removes the need for progesterone** ## Footnote Example: CEE + bazedoxifene.

Question 37

Name **ONE medication** classified as a steroid used for menopausal symptoms.

Answer 37

**Tibolone** ## Footnote Tibolone is a synthetic steroid that mimics estrogenic, progestogenic, and androgenic activity.