how do you define menopause?
no menses for 12 consecutive months
what is the most commonly reported symptom of menopause?
abnormal uterine bleeding
- 90% of women
- HMB, or heavy menstrual bleeding, when cycles become closer together/more often and heavier
OR
- cycles becomes farther apart/less often and lighter
what is a complication of abnormal uterine bleeding?
- anemia 2/2 HMB
what are some diagnostics for abnormal uterine bleeding 2/2 menopause?
- pregnancy HCG
- STI testing
- hematological parameters (CBC, LFTs, coagulation profile)
- serum hormone levels (TSH, FSH, estradiol, progesterone, testosterone, DHEAS)
1st line tx for AUB
medical management + hormonal management
medical:
- NSAIDs
- tranexamic acid
- desmopression (if underlying bleeding disorder)
hormonal:
- gonadotropin-releasing hormone (GnRH) agonists
- oral progestogens
- contraceptive options (low-dose oral contraceptive pills, depot MPA, and levonorgestrel-releasing IUD
average age of menopause?
50, means women will start noticing hormonal effects in their 40s
most common cause of irregular menses
anovulation - in menopause, women move to permanent anovulation
some other commom s/s of menopause
- vasomotor sx (hot flashes + night sweats)
- genitourinary changes (vulvovaginal atrophy)
- CNS changes (depression, sleep disturbance, decrease in sexual activity)
what are some characteristics of menopausal estrogen supplementation?
- look like low dose birth control because they have progesterone to prevent uninhibited estrogen effect at the endometrium (to prevent endometrial cancer)
- given for a little thermoregulation - not as high dose because not trying to shut down the whole FSH/LH/ovarian system like with birth control
contraindications for estrogen supplementation
- clotting disorders
- uncontrolled HTN
- cardiac disease
- smoking
- highest risk of cardiac effect is within 1st year of estrogen supplementation*
do hormones cause breast cancer?
no, except families with BRCA gene or early FH breast cancer
pathophysiology of endometrial cancer
proliferation of endometrial tissue from uninhibited estrogen effect at endometrium
risk factors for endometrial cancer
- never had kids
- never breastfed
- never birth control
how do we reduce the risk of endometrial cancer
putting on birth control or Mirena IUD
s/s endometrial cancer
AUB
diagnostics for endometrial cancer
EMB, endometrial biopsy
US
MRI
pharmocological tx for VMS (hot flashes, night sweats)
estrogen
- oral pills
- vaginal creams (Premarin, Estrace)
- vaginal estradiol rings (Estring, Femring)
- vaginal tablet, Vagifem
- transdermal patch
Lifestyle changes to manage hot flashes and night sweats
- Stay hydrated, avoid things that are dehydrating such as alcohol
- Recognize and avoid triggers such as spicy food, coffee, tight clothing, Etc.
- Sleep
- Exercise
- Reduce BMI
- Black Cohosh
- Red Clover
Treatment for genitourinary syndrome of menopause or Volvo vaginal atrophy
- vagifem
- Educate not to douche
Treatment for sleep disturbance
- Depends on mental health history
- Obstructive sleep apnea screening
- Estrogen is not a good treatment unless night sweats or hot flashes are waking them up
- Cognitive behavioral therapy or acupuncture for anxiety related
- Low dose Paxil (SSRI)
- Prometrium 100 mg at night: very safe, no side effects, no drug interactions, may help with night sweats too
- Prometrim is made in peanut oil so do not give it to someone with a peanut allergy
What are bio identical hormones?
- Synthetic, same risk factors of other hormones
- Estrovent: Made from plants, supplements
- They’re all different, made in compounding pharmacies
- Would not recommend at this time
What is Mona Lisa touch?
- Laser therapy for Volvo vaginal atrophy
- Placed in the vagina for five minutes
- At the beginning, treatment is every 3 to 6 months, then every 6 to 12 months
- Each treatment cost $3000-$5000, and it is not covered by insurance
- People say it makes their vagina feel much better
- Causes proliferation of cells of the vagina to help with lubrication
What are the take home points about menopause?
- Trying not to use estrogen
- Talk about lifestyle factors and sex lives
- Talk about lube in moisturizers
- Menopause is healthy aging
