Definition/Criteria

Question 1

Climacteric

Answer 1

the period of endocrinologic, somatic, and transitory psychologic changes that occur at the time of menopause

Question 2

Early/Late menopause

Answer 2

Menopause that occurs earlier or later than the normal ranges. Early is before 45. Late is after 54.

Question 3

Early/Late postmenopause

Answer 3

Early is within 8 years of the FMP. Late is >8 years after FMP.

Question 4

Induced menopause

Answer 4

the cessation of menses that comes after either surgical removal of both ovaries or iatrogenic ablation of ovarian fx (by chemo, pelvic radiation, or other forms of ovarian toxicity)

Question 5

Menopause transition (early/late)

Answer 5

The time before the FMP when menopause-related symptoms begin. Early is 7 or more days of differences in the cycle length; Late is 60 or more days of amenorrhea

Question 6

How many years prior to FMP and at what age does the menopausal transition occur?

Answer 6

~ 4 years or at 47 y.o.

Question 7

Perimenopause

Answer 7

Begins with the onset of menstrual irregularities and extends 12 months after FMP

Question 8

What is the average age (range) of menopause

Answer 8

51 with range of 45-55 y.o.

Question 9

Premature menopause/premature ovarian failure

Answer 9

Menopause that occurs before the age of 40

Question 10

What are the 2 Hormonal and Menstrual changes of the Early transition (-2)

Answer 10

-lengthening in the intermenstrual interval from 40-50 days.
- Early follicular phase FSH levels are high but variable

Question 11

Late transition (-1)

Answer 11

-skipped cycles
- episodes of amenorrhea
- increasing frequency of anovulatory cycles.
- typically lasts for 1-3 years before the FMP.
- The more irregular cycles are accompanied by more dramatic fluctuations in serum FSH and estradiol concentrations

Question 12

Menopause (+1 and +2)

Answer 12

12 months of amenorrhea; Increase in serum FSH becomes sustained near the FMP, then increases over several years to levels in the 70 to 100 international units/L range, followed by a decline with increasing age.

Question 13

Symptoms of menopause

Answer 13

The hallmark symptom is the hot flash. Other symptoms include vaginal dryness, sleep disturbances, a new-onset depression, joint pain and memory loss

Question 14

Hot flashes

Answer 14

aka vasomotor symptoms or hot flushes. Occurs in up to 80 % of women. They often cluster around menses during their late reproductive years, but symptoms are typically mild and do not require treatment. Symptoms become far more common during the MT. When hot flashes occur at night, women typically describe them as “night sweats.” VMS can persist for as long as 20 years past the FMP

Question 15

Sleep disturbances

Answer 15

May or may not be r/t hot flashes; which are more common at night and are associated with arousal from sleep. However, women experience sleep disturbances even in the absence of hot flashes.
Anxiety and depression symptoms may also contribute to sleep disturbances. In addition, perimenopausal women with hot flashes are more likely to be depressed. Primary sleep disorders are also common in this population.

Question 16

Depression

Answer 16

here is a significantly increased risk of new-onset depression in women during the MT than premenopausal years. The risk decreases in the early postmenopause.

Question 17

Vaginal dryness

Answer 17

The epithelial lining of the vagina and urethra are estrogen-dependent tissues, and estrogen deficiency leads to thinning of the vaginal epithelium. This results in vaginal atrophy (atrophic vaginitis), causing vaginal dryness, itching, and often dyspareunia. These symptoms are usually progressive and worsen as hypoestrogenism continues.

Question 18

Cognitive changes

Answer 18

Women often describe problems with memory loss and difficulty concentrating during the MT and menopause (substantial biologic evidence supports the importance of estrogen to cognitive function).

Question 19

Joint aches

Answer 19

• more common with women who are obese or depressed
• in general, peri- and PM women experiencing more joint pain than premenopausal women. It is unclear if the pain is related to estrogen deficiency or a rheumatologic disorder
• but in the (WHI), women with joint pain or stiffness at baseline were more likely to get relief with either combined estrogen-progestin therapy or unopposed estrogen.

Question 20

Other

Answer 20

Breast pain and menstrual migraines

Question 21

Long-term consequences of estrogen deficiency — while ovarian estradiol productions eventually stops, testosterone is still produced

Answer 21

●Bone loss – begins during the MT & is highest during the 1 year before the FMP thru 2 years after.
●Cardiovascular disease – risk increases after menopause.
●Dementia – There is limited epidemiologic support for the hypothesis that estrogen preserves overall cognitive function in non-demented women.
●Osteoarthritis – Estrogen deficiency after menopause may contribute to the development of osteoarthritis, but data are limited.
●Body composition – In the early postmenopausal years, women who do not take estrogen therapy typically gain fat mass and lose lean mass.
●Skin changes – The collagen content of the skin and bones is reduced.
●Balance – may be a central effect of estrogen deficiency. Problems with balance may play a role in the incidence of forearm fractures in women.

Question 22

Evaluation of women 45 and older

Answer 22

With irregular menstrual cycles with menopausal symptoms - no further diagnostic evaluation
Labs: (1) BhCG (2) prolactin (3) TSH (4) FSH
Women over 45 w/ irregular cycles and no other symptoms: a serum FSH >15 to 25 international units/L likely cause: menopausal transition

Question 23

Evaluation of women - Ages 40 to 45 years

Answer 23

Who present with irregular menstrual cycles, with or without menopausal symptoms:
●Pregnancy – Serum hCG
●Hyperprolactinemia – Serum prolactin
●Hyperthyroidism – Serum TSH

Question 24

Evaluation of women < 40 with irreg menses and menopausal symptoms

Answer 24

complete evaluation for irregular menses. If primary ovarian insufficiency (POI) is confirmed, further evaluation for this disorder should be performed.

Question 25

Atypical hot flashes or night sweats

Answer 25

evaluation for other disorders such as carcinoid, pheochromocytoma, or underlying malignancy is indicated.

Question 26

Women with heavy or prolonged bleeding

Answer 26

pregnancy test, determine if the bleeding is ovulatory or anovulatory, rule out structural abnormalities with pelvic ultrasound, and perform an endometrial biopsy if indicated.

Question 27

Women with underlying menstrual cycle disorders

Answer 27

we suggest measuring FSH concentration for diagnostic purposes.

Question 28

Women taking COCPs

Answer 28

COCs are considered to be safe in nonsmokers up to the age of menopause (average age 50 to 51 years).
Stop the pill and measure serum FSH 2-4 weeks later. A level ≥25 international units/L indicates that the patient has likely entered the menopausal transition. However, there is no FSH value that would provide absolute reassurance that she is postmenopausal.
Stop the pill by age 50 to 51 years, when the chance of conceiving is extremely low

Question 29

Posthysterectomy or endometrial ablation

Answer 29

Menopause cannot be determined using menstrual bleeding criteria. We suggest measurement of FSH concentrations. A serum FSH >25 international units/L, particularly in the setting of hot flashes, is suggestive of the LMT. For a postmenopausal woman, FSH would be considerably higher (in the 70 to 100 international units/L range).