Menopause Definition
lack of menses for 1yr
Perimenopause Definition
period of time surrounding menopause (2-8 yrs preceding + 1 yr after last menses) characterized by fluctuating hormone levels, irregular menstrual cycles, and symptom onset.
Menopause Types
- physiological
* average age 51 yrs (follicular atresia)- premature ovarian failure
- before age 40 (autoimmune disorder, infection, Turner’s syndrome)
- iatrogenic
- (surgical/radiation/chemotherapy)
- premature ovarian failure
Menopause Clinical Features
- associated with oestrogen deficiency
* vasomotor instability (tends to dissipate with time)
* urogenital atrophy involving vagina, urethra, bladder
* skeletal
* skin and soft tissue
* psychological
Menopause vasomotor instability features
- hot flushes/flashes
- night sweats
- sleep disturbances
- formication
- nausea
- palpitations
Menopause urogenital atrophy features (involving vagina, urethra, bladder)
- dyspareunia
- pruritus
- vaginal dryness
- bleeding
- urinary frequency
- urgency
- incontinence
Menopause skeletal features
- osteoporosis
- joint and muscle pain
- back pain
Menopause skin and soft tissue features
- decreased breast size
- skin thinning/loss of elasticity
Menopause psychological features
- mood disturbance
- irritability
- fatigue
- decreased libido
- memory loss
Menopause investigations
- Use absence of menses for 1 yr to diagnose
* decreased levels of estradiol (later)
Menopause treatment
- goal is for individual symptom management
- vasomotor instability
- urogenital health
- osteoporosis
- decreased libido
- cardiovascular disease
- mood and memory
Menopause vasomotor management
- HRT (first line)
- clonidine
- SSRIs
- venlafaxine
- gabapentin
- propranolol
Menopause urogential health management
- lifestyle changes (weight loss, bladder re-training)
* local estrogen replacement
* surgery
Menopause osteoporosis management
- 1000-1500 mg calcium daily, 800-1000 IU vitamin D, weight-bearing exercise, quit smoking
- bisphosphonates (e.g. alendronate)
- selective estrogen receptor modifiers (SERMs):
- – raloxifene - mimics oestrogen effects on bone, avoids estrogen-like action on breast and uterine cancer; does not help hot flashes
- HRT: second-line treatment (unless for vasomotor instability as well)
Menopause decreased libido management
vaginal lubrication, counselling, androgen replacement (testosterone cream or oral supplementation)
Menopause cardiovascular disease management
management of cardiovascular risk factors
Menopause mood and memory management
- antidepressants (first line), HRT (augments effects)
Menopause vaginal atrophy management
- local oestrogen
* cream
* vaginal suppository
* ring - lubricants
HRT Contraindications
ABCD A - Acute liver disease B - Undiagnosed vaginal Bleeding C - Cancer (breast/uterine) D - DVT (thromboembolic disease)
