Menopause

Question 1

Define and describe perimenopause/climacteric

Answer 1

• The time in which a woman has irregular cycles of ovulation and menstruation leading up to menopause and continuing until 12 months after her final period.
• Usually begins in the 40s, but may start as early as the late 30s

Question 2

What are some of the symptoms of perimenopause?

Answer 2

Not not women experience symptoms to the same degree

• Hot flashes,
• Night sweats,
• Weight gain
• Mood changes e.g. depression
• Vaginal dryness,
• Vaginal pain, and pain with sexual intercourse and breast pain
• Irregular menses
• Irregular bleeding - intermenstrual bleeding, postmenstrual bleeding, some periods may be abnormally heavy (menorrhagia)
• Headaches

Question 3

How long can the symptoms of the perimenopause phase and menopause last upto ?

Answer 3

Symptoms may begin up to 6 years before the final menstrual period and continue for a variable number of years after the final menstrual period

Question 4

Do women only recieve treatment of symptoms in menopause or do they also recieve treatment in the perimenopause phase if requried ?

Answer 4

The also recieve treatment for symptoms in the perimenopause phase if required so when talking about a treatments for certain symptoms I am talking about both in perimenopasue too although mainly menopause

Question 5

Define menopause

Answer 5

A biological stage in a woman’s life that occurs when she stops menstruating and reaches the end of her natural reproductive life. Usually it is defined as having occurred when a woman has not had a period for 12 consecutive months

Question 6

What causes the changes to occur in a women following menopause ?

Answer 6

The changes associated with menopause occur when the ovaries stop maturing eggs and secreting oestrogen and progesterone.

Question 7

What is the average age for menopause to occur ?

Answer 7

51

Question 8

What is defined as early menopause ?

Answer 8

Menopause occuring between 40-45yrs

Question 9

Define premature ovarian failure also known as premature menopause

Answer 9

Menopause occurring before the age of 40 years

Question 10

In general what are the causes of premature menopause ?

Answer 10

Natrually occuring or as a result of medical or surgical treatment.

Question 11

Define late menopause

Answer 11

Menopause occuring >54yrs

Question 12

Describe the physiology of menopause

Answer 12

As both the number and quality of egg cells in the ovaries decrease, the response of the ovaries declines, estrogen levels fall and levels of the hormones from the pituitary gland, Follicle Stimulating Hormone (FSH) and Luteinising Hormone (LH) rise.

Question 13

What are the effects of oestrogen ?

Answer 13

• Maintains female secondary sexual characteristics and glands e.g. breasts
• Hair distribution, body shape & fat distribution
• Effect on collagen
• Stimulates bone and muscle growth
• Stimulates endometrial thickening
• decreases cholestrol - helps prevent CVD

Question 14

What are some of the bad effects of having oestrogen ?

Answer 14

1. Oestrogen increases the chances of thromboembolitic disease (hence pill etc increses chances of clot)
2. Increases the chances of breast cancer and endometrial (uterine cancer)

Question 15

What are some of the problems whcih arise due to menopause and not having oestrogen now ?

Answer 15

1. Increased CVD risk
2. Atrophy of oestrogen dependant tissues e.g. genitalia, breasts & skin - vaginal dryness can be a result of this
3. Osteoporosis

Question 16

How is menopause diagnosed ?

Answer 16

Diagnose the following without laboratory tests i.e. clinical diagnosis in otherwise healthy women > 45 years with menopausal symptoms:

1. Menopause in women who have not had a period for at least 12 months and are not using hormonal contraception
2. Menopause based on symptoms in women without a uterus.

Question 17

When is perimenopause diagnosed and how ?

Answer 17

Diagnose the following without laboratory tests in otherwise healthy women aged over 45 years with menopausal symptoms:

1. Perimenopause based on vasomotor symptoms (hot flushes and night sweats) and irregular periods

Question 18

When is serum FSH test used to diagnose menopause ?

Answer 18

1. In women with suspected early menopause
2. In women with suspected premature menopause
3. Following hysterectomy with conservation of ovaries when there is no period pattern to observe, when unusual symptoms are present and when fertility appears to be reduced.

Question 19

Does a single raised serum FSH level confirm diagnosis of menopause ?

Answer 19

No you need to take at least 2 measurements 1 month apart - as there are other reasons for raised FSH levels

Question 20

What are some of the other causes of raised FSH levels/reasons for doing more than one test of serum FSH to confirm diagnosis ?

Answer 20

• Released in pulsatile fashion
• Raised just prior to ovulation
• Raised with stopping COCP or depo,
• Raised with breastfeeding or certain medication (SSRI)

Question 21

Should you use FSH serum test to diagnose menopause in someone on combined oestrogen and progestogen contraception or high-dose progestogen?

Answer 21

No

Question 22

What are some of the physical, psychological and sexual symptoms of menopause ? (note these present earlier)

Answer 22

Physcial

• Hot flushes
• Night sweats
• Palpitations
• Insomnia
• Joint aches
• Headaches

Psychological:

• Mood swings
• Irritability
• Anxiety
• Difficulty concentrating
• Forgetfulness

Sexual:

• Vaginal dryness
• Libido

Question 23

What are some of the later symptoms of menopause?

Answer 23

• Increase urinary frequency
• Recurrent UTIs
• Dysuria
• Incontinence
• Dry hair & skin
• Atrophy of breast and genitals