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Questions and Answers
What is menopause?
What is menopause?
A permanent end to menstruation.
What age do women typically experience menopause?
What age do women typically experience menopause?
Around 51 years.
Menopause is a normal process that affects all women reaching a suitable age.
Menopause is a normal process that affects all women reaching a suitable age.
True
What does postmenopause refer to?
What does postmenopause refer to?
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What is perimenopause?
What is perimenopause?
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What is considered premature menopause?
What is considered premature menopause?
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What hormones have high levels in menopause due to the absence of negative feedback from oestrogen?
What hormones have high levels in menopause due to the absence of negative feedback from oestrogen?
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Which of the following are symptoms of perimenopause? (Select all that apply)
Which of the following are symptoms of perimenopause? (Select all that apply)
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What risk is increased due to low oestrogen levels post-menopause?
What risk is increased due to low oestrogen levels post-menopause?
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What does a diagnosis of menopause rely on for women over 45 years?
What does a diagnosis of menopause rely on for women over 45 years?
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How long should effective contraception be used after the last menstrual period for women under 50?
How long should effective contraception be used after the last menstrual period for women under 50?
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Which contraception option is UKMEC 1? (Select all that apply)
Which contraception option is UKMEC 1? (Select all that apply)
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What is a key side effect of the progesterone depot injection?
What is a key side effect of the progesterone depot injection?
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How long might vasomotor symptoms last without treatment during perimenopause?
How long might vasomotor symptoms last without treatment during perimenopause?
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Study Notes
Menopause
- Menopause is the permanent cessation of menstruation, occurring on average around age 51.
- A retrospective diagnosis is made after 12 months without periods.
- Perimenopause describes the period before and after menopause, often characterized by vasomotor symptoms and irregular periods.
- It typically occurs in women older than 45 years and spans a year before and after the final menstrual period.
- Premature menopause occurs before the age of 40 due to premature ovarian insufficiency.
Physiology
- Follicles inside the ovaries mature into primary and secondary follicles independent of the menstrual cycle.
- FSH stimulates follicle development, leading to oestrogen production by granulosa cells.
- Menopause begins with a decline in follicle development, resulting in reduced oestrogen production.
- Oestrogen's negative feedback effect on the pituitary gland suppresses LH and FSH production.
- Falling oestrogen levels during perimenopause lead to increased LH and FSH as there is no negative feedback.
- Anovulation and irregular menstrual cycles occur due to failing follicle development.
- The lack of oestrogen causes amenorrhoea and perimenopausal symptoms.
Perimenopausal Symptoms
- A lack of oestrogen leads to symptoms including:
- Hot flushes
- Emotional lability or low mood
- Premenstrual syndrome
- Irregular periods
- Joint pains
- Heavier or lighter periods
- Vaginal dryness and atrophy
- Reduced libido
Risks
- Reduced oestrogen levels increase the risk of:
- Cardiovascular disease and stroke
- Osteoporosis
- Pelvic organ prolapse
- Urinary incontinence
Diagnosis
- Perimenopause and menopause can be diagnosed in women over 45 with typical symptoms without investigations.
- NICE guidelines recommend an FSH blood test for:
- Women under 40 with suspected premature menopause
- Women aged 40-45 with menopausal symptoms or changes in menstrual cycles
Contraception
- Fertility declines after age 40, but women should still be considered fertile.
- Pregnancy after age 40 carries increased risks and complications.
- Women should use effective contraception for:
- Two years after the last period for women under 50
- One year after the last period for women over 50
- Hormonal contraceptives do not affect the menopause itself, but can suppress and mask symptoms, making diagnosis difficult.
- Suitable contraceptive options include:
- Barrier methods
- Mirena or copper coil
- Progesterone-only pill
- Progesterone implant
- Progesterone depot injection (under 45 years)
- Sterilisation
- Combined oral contraceptives (UKMEC 2) can be used until age 50 if no contraindications exist in women over 40.
- Consider pills containing norethisterone or levonorgestrel in women over 40 due to lower venous thromboembolism risk.
- Progesterone depot injection (e.g. Depo-Provera) can lead to weight gain and reduced bone mineral density, making it unsuitable for women over 45.
Management of Perimenopausal Symptoms
- Vasomotor symptoms may resolve within 2-5 years without treatment.
- Management of symptoms depends on the severity and impact on daily life.
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Description
This quiz explores the significant aspects of menopause and its physiological changes. It covers the definitions of menopause, perimenopause, and premature menopause, as well as the hormonal changes involved in the process. Test your knowledge on this vital phase of women's health.
