Initial change signaling onset of menopause
Dec ovarian inhibin
Inc pituitary FSH
Menopause
12 month amenorrhea after LNMP
3 mos with FSH LH elevation
Fat and weight
Inc body weight
Gynecoid to android distribution
Skin and teeth
Collagen content dec
Teeth loss in upper jaw
GUT
Senile vaginitis (atrophy)
Urge incontinence
Uterine descent or prolapse due to dec collagen
Cysticoele rectocorle
Pathognomonic sign of menopause
Hot flush/flash
Long term effects
Inc CVD
Trabecular>cortical bone resorption
MC fracture in post menopausal women
Vertebra
Most accurate method to measure bone density
Dual Energy X ray
ERT
Dec vasomotor symptoms Stabilize trabecula Acidic vaginal pH Dec dyspareunia Inc breast cancer, heart disease, stroke, GB disease NOT ENDOMETRIAL CA
CI HRT
Undiagnosed vaginal bleeding Active thrombophlebitis Chronic impaired liver function Thromboembolic disease Hormonally dependent ca
Those CI for HRT use
SERM
Raloxifene: agonist at bone, antagonist at uterus and breast