Menopause

Question 1

Menopause- pathophysiology

Answer 1

Final menstrual period - after 1 year of 1 year

Question 2

Menopause- cause

Answer 2

Perimenopause - menopause transition
- months - years 
Induced menopause 
- cessation of menstruation
- oophorectomy or chemotherapy, pelvic radiation, iatrogenic 
Premature menopause 
- <40yo 
- natural or induced
- premature ovarian failure
- reason Unkown 
- associated w/ smoking 
Post menopause 
- years after FMP 
- 1/3 of lives

Question 3

Menopause- epidemiology

Answer 3

51 - avg age

- 44-55

Question 4

Menopause- S/S & PE

Answer 4

Change in menstrual cycle pattern
Vasomotor symptoms - night sweat, flushing
- transient episodes of flushing - intense heat on upper body and face
- perspiration, cutaneous vasodilation, palpitations
- goes away w/ time
Vulvovaginal symptoms - dyspareunia
-vaginal dryness, vulvovaginal irritation/inching, dyspareunia
- dysuria, urg incontinence, pelvic relaxation, atrophic cystitis, easy bleeding
- progressive and unlikely to resolve
- treat early
Urinary symptom
- atrophic vaginitis -> dec cervical mucus
- atrophy of uterus, fallopian tubes, ovary
Cognitive - memory concentration
Psychological - depression, anxiety, moodiness
CV - dis inc during this time as well
Sexual healthy
- dec libido
- dec estrogen -> decline virginal lubrication and elasticity
- dec testosterone -> dec in sexual desire/sensation
- high risk of STI
Sleep disturbances
- Peri and post sleep less -> more frequent insomnia
- hot flashes at night -> hard to sleep
Changes in menstrual - perimenopause - lots of hormone fluctuation
Bleeding - lighter, heavier, duration, cycle length, skipped, amenorrhea, AUB
Skin/hair changes - skin becomes thin, hair loss, nails become brittle, facial hair inc

Osteoporosis

• systemic skeletal disorder - low bone mass and deterioration w/ inc risk in fragility and susceptibility to fracture
• peak bone mass - 25-30 -> lose up to 20% of bone mass in 5-7yr post menopause

Question 5

Menopause- diagnosis

Answer 5

FSH >30 + 1 year of no period

Question 6

Menopause- labs & imaging

Answer 6

Not typical to do blood work

Estradiol - <20
FSH - 21-100
AMH - inc = less function

STD screen -> at risk for STDs b/c of vaginal atrophy and stop using condoms

Question 7

Menopause- treatment

Answer 7

Vasomotor
- Estrogen, progestin, Clonidine, SSRI, SNRI, black cohosh, Gabapentin
Vaginal
- lubricants, moisturizers, local vaginal estrogen
Sex life
- lubricants, moisturizers, local vaingal estrogen
Kegel

Hormone therapy - osteoporosis, vasomotor, vulvovaginal atrophy
Estrogen therapy
- systemically - don’t have a uterus
- topical/local - low dose for everyone else
Estrogen-progestogen therapy
- progestogen added - protect uterus against endometrial cancer
Bioidentical hormone therapy
- hormones chemically identical or similar to those made in the body
- FDA approved and tested
- unapproved/untested from compounding pharmacies

Alternatives

• antidepressant - SSRIs, SNRIs
• Insomnia - eszopiclone
• Anticonvulsant - gabapentin
• Antihtn - clonidine
• neuropathic pain drug - pregabalin

Question 8

Menopause- prognosis

Answer 8

Hormone therapy risks

• Thrombosis, stroke, CV events
• EPT - breast cancer risk
• ET - endometrial cancer risk

Contraindications

• Active DVT/PE - or hx
• arterial thromboemobolic disease - MI or Stroke
• liver disease
• hx of endometrial or breast cancer - personal, not fm