What is the definition of climacteric?
Phase in a woman’s reproductive life when a gradual decline in ovarian function results in decreased sex steroid production, and the associated sequelae
Which phases of menopause do you see irregular menses?
Menopausal transition and perimenopause
When is the menopausal transition? When is Perimenopause?
Menopausal transition: Incr. FSH–> FMP (final menstrual period)
Perimenopause: Incr. FSH–> 12mo after FMP
When is a women considered to be in menopause
12 months of amenorrhea after FMP in a woman > 45y/o in the absence of other biological or physiological causes
Menopause typically occurse between what ages?
50-55
(51-52 in the US)
S/s of what?
- Changes is menstrual cycles (irregular, heavy)
- Mood/emotional changes
- Hot flashes
- Night sweats
- Breast changes (incr. tenderness early on)
- Loss of libido
- etc
Menopause
What are the 4 hormonal chages found in menopause?
- Decr. estrogen
- Decr androgens ( see facial hair growth and decr. breast size)
- Decr. In progesterone (irreg vag bleeding)
- Incr. LH/FSH
What are the 3 physical changes seen in menopause
- Urogenital atrophy (vulvovaginal atrophy, etc)
- Urinary stress incontinence
- Skin collagen loss
What 3 diseases are seen in menopause
- Osteoporosis
- CV disease
- Dementia
How do you treat atrophic changes, vaginal dryness in menopause?
- 1st line= non-hormonal vaginal moisturizers and lubricants
- most effective: Vaginal estrogen therapy
- Ospemifene (a SERM)
- Vaginal prasterone (DHEA)
POPCORN
T/F: Women who still have a uterus should be given unopposed estrogen as tx for menopause
FALSE
Women who still have a uterus should NOT use unopposed estrogen!!
What is the gold standard for relief of vasomotor sxs a/w menopause
Menopause Hormone Therapy (unopposed estrogen therapy or combined estrogen-progestin therapy)
What are the 7 contraindications to menopause hormone therapy
- H/o breast cancer
- CHD
- Prior VTE or stroke
- Liver disease
- Unexplained vaginal bleeding
- High-risk endometrial cancer
- TIA
How should you prescribe Menopause Hormone Therapy?
the lowest effective dose for the shortest period of time
The following are examples of what?
- Prempro, Prefest, Climara pro (estrogen/progestin)
- Estratest (estrogen/testosterone)
- Premarin, Femtrace, Climara (Estrogen only)
- Duavee (bazedoxifene/estrogen)
Menopause Hormone Therapy
Which study showed increased risk of CHD, stroke, VTE and breast cancer and resulted in many providers to discontinue prescribing Menopause hormone therapy, however, was later found to not be a great study?
Women’s health initiative
Clinical bottom line of Menopause HRT?
- Tx symptomatic women only
- Benefits > risks of women under 60
- Benefits > risks if < 10 years from menopause
- do NOT use MHT for prevention of chronic diseases (CHD, osteoporosis)
How long should MHT be used for
< 5 years
