Menopause

Question 1

State 5 causes of premature menopause

Answer 1

1. Chromosomal abnormality (e.g. turner’s syndrome or fragile X
2. Autoimmine disorder
3. Infection
4. Surgery
5. Consequence of cancer treatment

Question 2

Diagnosis of menopause

Answer 2

Is based on symptoms and menstrual irregularities

Question 3

What tests can support menopause diagnosis

Answer 3

1. FSH/LH/Oestradiol (repeated 6 weeks apart)

2. Thyroid function tests

Question 4

How is menopause treated?

Answer 4

Hormone replacement therapy (HRT)

Question 5

What 3 things can test ovarian reserve?

Answer 5

3D ultrasound to measure number of eggs
FSH measurements
Anti-mullerian hormone (Most accurate)

Question 6

Explain the compositions of FSH, LH and oestrogen post-menopause

Answer 6

Hypothalamus still causes release of GnRH so anterior pituitary releases FSH. However no eggs so no feedback via oestrogen so FSH and LH rises and oestrogen levels decrease.

Question 7

Describe the mechanism of action of HRT

Answer 7

It is a steroid hormone that can bind to either Oestrogen receptor alpha or beta.
1. Hormone diffuses into cytoplasm
2. Binds to receptor 
3. Translocated to nucleus
4. Alters gene transcription
5. Creates new mRNA 
6 Translation of new proteins

Question 8

How does the presence of a uterus affect HRT?

Answer 8

Without a uterus HRT is just oestrogen (orally)

With uterus HRT is oestrogen and progesterone

Question 9

Describe continuous HRT and who is it appropriate for?

Answer 9

Oestrogen and progesterone given daily with out a break (post-menopausal)

Question 10

Describe sequential HRT and who it is appropriate for

Answer 10

Continuous oestrogen but sequential progesterone (recommended for peri-menopausal)

Question 11

Describe testosterone as a treatment for menopause

Answer 11

Improves symptoms of libido, energy, mood, concentration (given as gel, patch or implant)

Question 12

List 5 symptoms of HRT from oestrogen

Answer 12

Fluid retention, nausea, headaches, breast tenderness, leg cramps

Question 13

List 4 symptoms of HRT from progesterone

Answer 13

1. Irregular bleeding
2. PMS
3. Bloating
4. Depression

Question 14

List 4 ways to reduce side-effects of HRT

Answer 14

1. Reduce dose
2. Take with food
3. Change type of hormone
4. Change route of administration

Question 15

State 5 HRT alternatives

Answer 15

1. Selective oestrogen receptor modulator
2. Selective serotonin reuptake inhibitors (SSRI) low dose
3. Serotonin-norepinephrine reuptake inhibitors (SNRIs) low dose
4. Antihypertensives (alpha agonists)
5. Antiepileptic

Question 16

Describe the mechanism of action of Selective oestrogen receptor modulators

Answer 16

1. Selectively binds to receptors depending on tissue type

2. Is simultaneously oestrogen and anti-oestrogenic in different tissues

Question 17

How long should contraception be used since last period?

Answer 17

2 years if under 50

1 year if over 50