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Menopause quiz

  • Symptoms of menopause:
    • Hot flushes, loss of libido, memory loss, inability to fall pregnant, urinary incontinence, rapid heart beat, vaginal dryness, weight gain, dry skin, hair loss, insomnia, osteoporosis, increased risk of breast cancer, mood swings, depression
  • Lack of sexual desire is due to a drop in the male hormone testosterone
  • Hot flushes during menopause are controllable and sometimes never happen
  • Bone loss during menopause is inevitable but can be lessened through taking natural or synthetic hormones, performing weight-bearing exercises and eating a calcium-rich diet
  • No treatment can alleviate all the symptoms of menopause
  • Stigma, taboo
  • Breast cancer
    • Markers: genetics, biochemical
    • Diagnosis (stage, grade, type)
    • Screening
    • Histopathology
    • Management e.g. surgery, chemo, radio, hormone
  • Menopause people = estrone
  • Estradiol = premenopausal
  • Estriol = pregnant women
  • Androstenedione = an androgen, precursor of sex steroids.
  • Phytoestrongens = plant chemicals that have estrogenic activity
  • In menopausal women, inhibin, estrogen, progesterone and testosterone decrease and FSH, LH increase (lack of negative feedback).
  • Women before and during menopause lack sexual desire due to a fall in the male hormone testosterone
    • Also affected by physical (vaginal dryness) and psychological factors
  • Hot flashes are controllable and sometimes never gappen (75% of women get hot flashes. Can be controlled by oestrogen replacement, reduction of trigggers, and clonidine, paroxetine and gabapentin)
  • Flashes are often preceded by an increase in core temperature
    • Vasodilation
    • Warming the torso provockes it
    • NA is elevated in brain
    • Yohimidine increases it
  • Bone loss during menopause is inevitable but can be lessened through HRT, weight-bearing exercises and eating Ca diet. PEPI (postmenopausal E/P interventions).
  • Estrogen stimulates TGFB production. Estrogen effects on bone are mediated by ERa. Estrogen stimulates development of osteoblasts.
    • TGFb causes apoptosis of osteoclasts.
    • ERb doesn't do things in bone

Menopausal myths

Group 1

Question 1

  • Estrogen, progesterone, LH, FSH
    • Abrupt removal of these hormones causes exacerbated withdrawal symptoms
    • Estrogen ‘addiction’ important
  • Estrogen stimulates endometrial, uterine growth, secondary sexual cahracteristics, procoagulant, cardioprotective (HDL / LDL profile), stimulates osteoblasts, inhibits osteoclasts, accelerates metabolism, triggers LH release causing ovulation
  • Progesterone, supports and enriches the endothelium of the uterus to support pregnancy, produces in corpus luteum and assists in milk production, assists cervical mucus

Question 2

  • See menopause lecture

Question 3

  • Still a chance of falling pregnant after menopause, but drastically reduced
  • Menopause decreases risk of breast cancer
  • The other symptoms listed in the SG guide are legit
    • See Karen Gibson's lecture.

Question 4

  • Same symptoms, but worse due to sudden withdrawal
  • Symptoms occur because of the withdrawal e.g. doesn't occur in Turner's syndrome
  • Note natural menopause vs induced menopause

Question 5

  • Body hasn't yet matured at that age, so dependence on the hormones hasn't developed yet
  • No withdrawal has occurred

Group 2

  • HRT
    • Reduces osteoporotic risk, helps symptom control of menopause
    • Once an atheroma has formed, giving HRT doesn't reverse disease (can be bad because of prothrombotic effects). Oestrogen suppresses occurrence of atheromas due to oestrogen increasing HDL, but once it's started, HRT doesn't help.
    • HRT = livial
    • Breast cancer due to HRT is rare (8/10000)
    • Decreases risks of bowel and uterine cancer
    • Overall cancer risk is the same; also reduces osteoporosis and strokes
    • Inconclusive evidence w.r.t. dementia and heart disease
    • Look at family history of breast cancer
  • Alternative therapies
    • Vitasoyasn
    • Remifemin


Review the newspaper article on HRT, and then read the supporting material on HRT.

  1. What is HRT? Are there different types?
    • Boost deficient hormone levels
    • Put in estrogen with progesterone or progestin, because unopposed estrogen increases the risk of endometrial carcinoma
    • Pills
    • Transdermal Patches
    • Vaginal estrogen ring.
    • Topical estrogen.
  2. What are the risks/benefits of HRT? (”I would rather lose my breast than my mind”). How are these assessed?
    • Prolonged HRT in 65yo increases relative risk of breast cancer by 8/10000
    • Assessed by age, no significant risk for people under 60.
    • Familial breast cancer risk should be assessed.
    • History of cancers etc.
  3. How long should a woman remain on HRT? What happens when she stops the therapy?
    • If therapy stops, symptoms may return.
    • As long as needed based on risk.
    • 3-5 years, or as long as you need for your menopause
    • Long term = premature ovarian failure or suffer from osteoporosis
  4. What alternative therapies are available? Are they effective?
    • SSRIs, SNRIs - reduce hot flushes.
    • Gabapentin - reduces hot flushes.
    • Clonidine - blood pressure medicine, reduces frequency of hot flushes.
    • Black Cohosh - relieve hot flushes
    • Phytoestrogens - act like estrogen, relieve hot flushes, estrogen dependent cancers are bad
    • Dong quai - don't take with warfarin, useless
    • Kava - reduce anxiety, dangerous for liver
    • Gingseng - improve mood swings
    • Valerian - helps with sleep disturbances. A/E: dizziness, upset stomach, tiredness
    • Vitamin E - relieve hot flushes
    • Melatonin - regulates sleep cycles
    • Yoga - deep breathing
    • Focused breathing - relieve hot flushes
    • Mindfulness meditation - manage stress
    • Acupuncture - magic?
    • Aromatherapy - magic?
    • Massage - relaxation therapy, helps stress, fatigue

Other than HRT, nothing addresses all the symptoms at once.

Group 3

  • Male menopause – debateable existence
  • Androgen levels decrease with age (by about 1% per year from 30 years)
    • Can result in depression, nervousness, menopause like symptoms
  • Some of these may be due to ageing
  • Men do experience a decline in the production of the male hormone testosterone with aging, but this also occurs with conditions such as diabetes. Along with the decline in testosterone, some men experience symptoms that include fatigue, weakness, depression, and sexual problems. The relationship of these symptoms to decreased testosterone levels is still controversial.
  • Unlike menopause in women, when hormone production stops completely, testosterone decline in men is a slower process. The testes, unlike the ovaries, do not run out of the substance it needs to make testosterone. A healthy male may be able to make sperm well into his eighties or longer.
  • However, as a result of disease, subtle changes in the function of the testes may occur as early as 45 to 50 years of age, and more dramatically after the age of 70 in some men.
  • This relates to the slow but steady reduction of the production of the hormones testosterone and dehydroepiandrosterone in middle-aged men, and the consequences of that reduction, which is associated with a decrease in Leydig cells.
  • A steady decline in testosterone levels with age (in both men and women) is well documented. However, in women, it is the decrease in the hormone estrogen that causes menopause, while testosterone loss causes andropause in men. Unlike "menopause", the word "andropause" is not currently recognized by the World Health Organization and its ICD-10 medical classification. *While the words are sometimes used interchangeably, hypogonadism is a deficiency state in which the hormone testosterone goes below the normal range for even an aging male.
  • Lots of stuff actually related to ageing, not to male menopause