Menopause

Question 1

what is the definition of menopause

Answer 1

• this is a year after the women had her last menstrual periods

Question 2

how many people does menopause occur in

Answer 2

12 million

Question 3

what is the average age of menopause

Answer 3

52 - in markscheue

(51.4) or 51-52

Question 4

what is the life expectancy of a women

Answer 4

82

Question 5

what is the early menopause

Answer 5

20% of women aged 40-45yrs

Question 6

what is premature menopause

Answer 6

1% of women lower than the age of 40

Question 7

what is perimenopause/ climacteric

Answer 7

this is the time leading up to and around the menopause

- it is the transitional phase during which reproductive function decline and ceases

Question 8

if menopause occurs around the age of 50 than the perimenopause can last for..

Answer 8

1-3 years

Question 9

what are the climacteric symptoms

Answer 9

Changes in length of menstrual cycle

Hot flushes / night sweats

If menopause at 50 yrs, climacteric begins a year earlier

If menopause less than or equal to 40 yrs, climacteric begins 4 years earlier

Question 10

what are the symptoms of menopause due to

Answer 10

• an decrease in oestrogen this is mainly due to the ovarian reserve being depleted

Question 11

what are the types of symptoms experienced in menopause

Answer 11

• short term symptoms

- long term symptoms

Question 12

Name the short term symptoms that occur

Answer 12

• vasomotor
• psychological
• urogenital
• collagen

Question 13

describe the short term symptoms that occur

Answer 13

Vasomotor - hot flushes and night sweats, headaches, palpitations

Psychological - depression, mood swings, insomnia, memory loss, panic

Urogenital urinary frequency, dysuria, stress & urge incontinence, vaginal dryness, dyspareunia (pain with sex)

Collagen - dry inelastic skin, brittle nails, hair loss, joint/muscle pain

Question 14

what is the most frequent short term symptom

Answer 14

• vasomotor symptoms

- these are mainly related to oestrogen

Question 15

in how many women do psychological symptoms occur in

Answer 15

occurs in 50% of women

Question 16

what are the long term consequences of menopause

Answer 16

CVS
Skeletal 
skin 
genito-urinary 
psychological

Question 17

describe the long term consequences of the symptoms of menopause

Answer 17

CVS - hyperlipidemia, ischaemic heart disease

Skeletal - osteopenia & osteoporosis

Skin - inelastic thin flaky skin, easy bruising

Genito-urinary – atrophic changes, prolapse, incontinence,
depressed libido & dyspareunia

Psychological - Alzheimer’s Disease

Question 18

how is oeseoporosis pathophysiological caused in women with menopause

Answer 18

• In the bones there is a balance between reabsorption and oestogensis in menopause resorption increases by oesotgensis decreases thus there is a reduction in bone mass

Question 19

what women is otesoporsis common in

Answer 19

Common in white women
- (50% have 1 fracture by 82 years)

Lowest risk in Afro-Carribeans

Question 20

what happens to the uterus during menopause

Answer 20

can prolapse

• there can be utero-vaginal prolapse - this is when the uterus is 2nd degree as it does not go through the vagina
• there can be 3rd degree prolapse this is when it goes completely through the vagina

Question 21

how can you diagnose menopause

Answer 21

• triad of diagnostic features include - typical symptomatology, 12 months amenorrhoea, FSH greater than 15 iu/ml
• serum estradiol levels (decreases) - these are only useful at the age of less than 45 years, these

Bone mineral densitometry (this decreases as well)
- this is helpful int he diagnosis of osetoprosis

Question 22

what are the 2 treatments for menopause

Answer 22

• hormone replacement therapy (HRT)

- non-hormonal treatments

Question 23

what are the two types of HRT

Answer 23

if uterus present :
oestrogen + progesterone

If uterus absent :
oestrogen alone

Question 24

why do you give oestrogen and progesterone as a hormone related therapy if you have a uterus

Answer 24

-If you only give oesrogen – lining will become thick and lead to metaplasia therefore you need to give progesterone at the same time

Question 25

what are the routes of administration for HRT

Answer 25

``` Oral Patches and gels Implants & Injections – 6 months Intravaginal creams, pessaries, rings Nasal sprays ```

Question 26

what is the problem with oral absorption

Answer 26

- it is not very stable but it may help for a little bit

Question 27

how often do you change the HRT transdermal patches

Answer 27

change them twice a week

Question 28

what are the gels and creams that can be used

Answer 28

oestrogel - Gel rub on arm and leg 2 lines per day - If more symptoms they can go up to 3 or go down to 1 line - If they have a uterus you need to give progesterone

Question 29

what are the common side effects of HRT

Answer 29

Heavy cyclical / Unscheduled irregular bleeding Bloating, fluid retention and weight gain Mastalgia – pain on the breast Headaches, Muscle cramps, Abdominal pain Depression

Question 30

what are the serious complications of HRT

Answer 30

Breast cancer - risk increases >5yrs of use, by approx 2-6/1000 women Thrombo-embolic events - DVT / PE affect approx 5/10,000 women on HRT, and most commonly occur in the first year of use

Question 31

what are some non-hormonal treatments

Answer 31

Biphosphonates & Calcitonin : Decrease osteoclast activity Selective estrogen receptor modulators (SERM) Clonidine & Venlaflaxine : Reduce vasomotor symptoms

Question 32

what are the lifestyle issues with menopause

Answer 32

Vitamins Herbs Phyto-oestrogens Exercise No smoking