Menopause

Question 1

What are the clinical features of menopause?

Answer 1

Up to 80% of women experience vast motor symptoms for an average duration of 5 years

Vasomotor

• hot flushes
• night sweats
• palpitations
• light headedness/ dizziness
• migraine

Psychomotor

• irritability
• depression
• anxiety/ tension
• tearfulness
• loss of concentration
• poor short term memory
• sleep disturbance
• mood changes
• loss of self confidence

Urogenital

• atrophic vaginitis
• vaginal dryness
• dyspareunia
• decline in libido
• bladder dysfunction eg dysuria
• stress incontinence/ prolapse

Musculoskeletal
- non specific aches and pains

Skin and tissue changes

• dry skin
• new facial hair
• breast glandular tissue atrophy

Other

• fatigue
• headache

Question 2

What are contraindications to HRT?

Answer 2

Oestrogen dependent tumour eg endometrial cancer, breast cancer
Recurrent thromboembolism
Acute ischaemic heart disease
Cerebrovascular disease
Uncontrolled hypertension 
Undiagnosed vaginal bleeding
Active liver disease
Active SLE
Pregnancy
Otosclerosis
Acute intermittent porphyria

Question 3

What follow up should be done after commencing HRT?

Answer 3

3 months after starting (ideal time for mammogram) then 6 monthly

Question 4

What is menopause?

Answer 4

Cessation of menses for longer than 12 months
In most western women it occurs between 45 and 55 with an average age of 50-51
Women can be premenopausal for up to 5 years before the menopause

Question 5

What are contraindications for HRT?

Answer 5

Oestrogen dependent tumour
Recurrent thromboembolism 
Acute ischaemic heart disease
Coronary artery disease
Cerebrovascular disease
Uncontrolled hypertension 
Undiagnosed vaginal bleeding
Acute liver disease
Pregnancy 
Otosclerosis 
Acute intermittent porphyria