Learning outcomes:

• Menopause - signs, symptoms, investigations, management
• Recognition of need of HRT based on Sx and/or future risk of degenerative disorders
• Appropriate differentials for menopause
• Management - indications for different types - advantages and disadvantaged of HRT
• Concept of disease prevention - risk of cardiovascular disease and osteoperosis

Differential diagnosis

• menopause

The following menopausal Sx may be caused by other conditions:

• Secondary amenorrhoea
  • contraceptive use (IUS)
  • POI
  • PCOS
  • pituitary tumour
  • Drugs - antipsychotics increase prolactin, cocain/opiates can cause hypogonadism
  • thyroid disease
• irregular vaginal bleeding
  • endometrial polyps
  • fibroids
  • adenomyosis - endometrial tissue growns into myometrium
  • cancer (endometrial, cervical, vulval)
• Hot flushes
  • Endocrine - hyperthyroidism, phaeochromocytoma
  • tumours - carcinoid syndrome, pancreatic Ca, medullary thyroid Ca, RCC, lymphoma, paraneoplastic syndrome
  • excess alcohol consumption, spicy food
  • anxiety, panic disorders
  • TB
  • drugs - opiates, nitrates, SSRI, CCB, GnRH anatogonists, SERMs
• Vaginal atrophy
  • trauma
  • infection
  • lichen sclerosis