Menopause

Question 1

What is the average age of menopause in the UK?

Answer 1

51 years old

Question 2

What are the diagnostic criteria for menopause?

Answer 2

• 12 months after the last period in women > 50 years
• 24 months after the last period in women < 50 years

Question 3

What advise would you give someone who is asking about contraception?

Answer 3

To use contraception until diagnosis is sure.

(12 months or 24 months after last period depending on age group)

Question 4

What are the indications for using HRT?

Answer 4

To treat symptoms of menopause

• Vasomotor symptoms such as flushing, insomnia and headaches
• Premature menopause: should be continued until the age of 50 years. Most important reason is preventing the development of osteoporosis

Question 5

How long does fertility last for after menopause?

Answer 5

Exactly the same amount of time (on average) as the diagnostic criteria.

Question 6

What lifestyle advise should be given for women going through menopause?

Answer 6

• Regular exercise
• Avoid caffeine/spicy foods
• Lighter clothing

Question 7

What are some non-hormal methods of treating menopause and when would you use them?

Answer 7

• Use for control of vasomotor symptoms (Hot flushes, night sweats)
• SSRI
• Clonidine(MOA Sympatholitic):
  
  • Use is often limited by side-effects: Dry mouth, dizziness and nausea
• Progestogen such as norethisterone

Question 8

How do you treat vaginal symptoms in menopause?

Answer 8

• Vaginal atrophy may be helped by topical oestrogens
• If the symptoms are predominately vaginal dryness then a vaginal lubricant or moisturizer

Question 9

What is the difference in treating a menopausal woman with hysterectomy versus a woman with a uterus?

Answer 9

Unopposed estrogen if hysterectomy

Combination HRT if womb

Question 10

Why should women with a uterus not be given unopposed estrogen?

Answer 10

They are at risk of endometrial hyperplasia which can then become cancerous if they only use oestrogen.

Question 11

What are the 2 types of combined HRT and in what scenarios are they used?

Answer 11

1. Continuous HRT - Postmenopausal
2. Cyclical HRT - if still having periods.

Question 12

What can be used if urogenital symptoms are a problem?

Answer 12

Topical oestrogens

Question 13

Give a rough outline of the treatment regime for cyclical HRT?

Answer 13

Oestrogen is started on day one of the period.

Progestogen is started on day 14 followed by withdrawal bleeding.