meno

Question 1

Menopause:

Perimenopause:

Premature Ovarian Failure:

Post Menopause: t

Answer 1

Menopause: Cessation of menstrual periods confirmed after x 1 year without menses

Perimenopause: waxing and waning estrogen levels followed by erratic menstrual bleeding leading up to the final menstrual period. Average time is 3-5 years. Average age 47.

Premature Ovarian Failure: amenorrhea due to ovarian insufficiency <40yrs of age

Post Menopause: the years after confirmation of menopause

Question 2

Average age of menopause in North America

Average age of perimenopause

Answer 2

menopause 51 yrs.
perimenopause is 47 yrs.

Wide range of variability on average 40-58 yrs. and is genetically determined

Question 3

ddx

Answer 3

• Pregnancy
• Thyroid and pituitary dysfunction
• Fibroids
• Endometrial abnormalities (hyperplasia, polyps, endometriosis)
• Cancer
• Coagulopathies

Question 4

tx

Answer 4

No OC is government approved in Canada for treating abnormal uterine bleeding

MIRENA – approved in 2010 for menorrhagia
Low dose OCP for contraception*

NSAIDs: decrease blood flow by 20-50%; start 24-48 hours before menses and continue for 5 days or until cessation of menses
Ibuprofen 600 mg OD
Naproxen 500mg at onset, again 3-5 hours later, then 500mg BID

Mefenamic Acid 500mg TID
Tranexamic Acid: antifibrinoltyic agent, 40-60% reduction in menstrual flow
Cyklokapron 100o to 1500 TID-QID