Menopause and HRT 5

Question 1

What are the major steps in diagnosing perimenopaus?

Answer 1

• Clinical diagnosis, look for cardinal symtpoms
• FSH levels are too variable in this age group to be useful
• In postmenopausal years:
  
  • FSH > 40 mlU/ml
  • E2 < 25 pg/ml
• Use lab tests to rule out other diagnoses:
  
  • hypothyroidism
  • hypothalamic amenorrhea
  • hyperprolactinemia
  • PCOS
  • non-GYN diseases
  • POF

Question 2

What is the prognosis of perimenopausal symptoms?

Answer 2

• Cardinal symptoms resolve over tie if untreated
  
  • 12% will have long-term/lifetime symptoms
• Vulvovaginal atrophy will not get better without treatment
  
  • will often get worse if not treated
• Increased risk for clinical depression returns to baseline risk in postmenopausal years

Question 3

What are some factors to properly handling patients who present with perimenopause?

Answer 3

• Informed consent
• Discuss all:
  
  • pros/cons
  • risks/benefits
  • indications
  • treatment alternatives
• Document this in medical record
• For high risk patients, consider signed, written consent
• Make sure patient has had exam and updated lbas like:
  
  • chemistries
  • lipid panel
  • thyroids screen