Patient will present as → a 52-year-old female with no menses for 12 months she also complains of hot flushes and dyspareunia
Menopause is a clinical diagnosis and is defined by
- Cessation of menses for at least 12 months
- FSH > 30 (although not necessary for diagnosis)
Perimenopause – the transition between reproductive capability and menopause hallmark is irregular menstrual function, lasts 3-5 years
Average age 51.5 years (44-55 years old)
- On average women will spend 30+ years in the postmenopausal state
- Onset < 40 years old = premature ovarian failure
For health women 45 +
FSH and estradiol levels (FSH > 30) with ↓ estradiol
Menopause is a retrospective diagnosis based on 12 or more months of amenorrhea occurring at a mean age of 51 years
- The diagnosis is based on the appropriate age of a female patient for menopause (range, 45 to 55 years), symptoms of frequent classic “hot flashes,” night sweats, and the association of these symptoms with the cessation of menses
Women 40 - 45 years who present with irregular menstrual cycles and menopausal symptoms may be in the menopausal transition
- Same endocrine evaluation as for any woman with oligo/amenorrhea: serum human chorionic gonadotropin (hCG), prolactin, TSH, FSH
Women under age 40 years with irregular menses and menopausal symptoms,
- Complete evaluation for premature ovarian failure
Hormonal Therapy: Estrogen and Progesterone replacement – Only indicated in symptomatic women
If uterus - HRT (estrogen + progesterone), if no uterus (ERT)
- For women who have had a hysterectomy, estrogen is used alone
- Oral, transdermal (patch, lotion, spray, or gel), or vaginal forms may be used. Treatment should start with the lowest dose; the dose is increased every 2 to 4 wk as needed.
- Low doses include 0.3 mg PO once/day (conjugated equine or synthetic estrogens), 0.5 mg PO once/day (oral estradiol), and 0.025 mg once/day (estradiol patch)
- Women who have a uterus should be given progestin in addition to estrogen because unopposed estrogen increases the risk of endometrial cancer. The progestin is taken with estrogen continuously (ie, daily) or sequentially (12 to 14 consecutive days of every 4 wks)
For vaginal dryness, recommend vaginal stimulation and OTC vaginal lubricants and moisturizers, and if they are ineffective, prescribe low-dose vaginal estrogen creams, tablets, or rings.
Non-hormonal therapies: Cool temperatures, avoid hot, spicy foods or beverages, avoid ETOH, exercise, soy
- Alternative drugs for vasomotor symptoms
- SSRIs (paroxetine)
|Menopause is described by decreased estrogen production due to age-linked decline in ovarian follicles. It is defined as one whole year without ovulation, and the average age of menopause is 51 years old. Symptoms can be remembered with the HAVOCS mnemonic: Hot flashes, Atrophy of the Vagina, Osteoporosis, Coronary artery disease and Sleep disturbances.|
generalized anxiety disorder
thyroid hormone replacement
There is no strong evidence that this patient has hypothyroidism, and there is certainly no indication for empirical use of thyroid hormone without objective evidence of hypothyroidism (i.e., thyroid-stimulating hormone and thyroid function test).
estrogen with progestin therapy (hormone therapy [HT])
Antidepressants might help alleviate some of this patient’s symptoms, especially if she was also clinically depressed. However, this patient’s symptoms are most likely hormonally related, and HT/ ET alone often alleviates both the affective and the somatic symptoms of menopause.
estrogen alone (estrogen therapy [ET])
This patient still has her uterus, and ET (estrogen alone) is not recommended because of the significantly increased risk of endometrial hyperplasia or cancer with prolonged unopposed estrogen use.
progestin/ progesterone alone
A progestin or progesterone alone may alleviate some of this patient’s symptoms, but her symptoms are related primarily to estrogen deficiency and thus respond best to ET.
all of the above
combined equine estrogen (CEE) appears to cause breast cancer
CEE appears to cause coronary heart disease (CHD)
medroxyprogesterone acetate appears to cause breast cancer
medroxyprogesterone acetate appears to cause CHD
daily combined use of 0.625 mg CEE and 2.5 mg medroxyprogesterone acetate progesterone (MPA) should not be initiated or continued for the primary prevention of CHD
intravaginal estrogen creams or tablets
an intravaginal estrogen ring
increased foreplay and intercourse
all of the above
selective serotonin reuptake inhibitors (SSRIs) and selective serotonin and norepinephrine reuptake inhibitor (SSNRIs)
all of the above