Menopause details

Menopause details :-

Menopause

Definitions –lack of menses for 1 yr

Types of menopause –physiological –average age 51 yr ,premature ovarian failure {before age 40 –autoimmune disorder ,infection ,turner’s syndrome},iatrogenic –surgical ,radiation ,chemotherapy

Clinical features – associated with estrogen deficiency

Vasomotor instability –hot flashes ,night sweats ,sleep disturbances ,formication ,nausea ,palpitation

Urogenital atrophy involving vagina ,urethra ,bladder –dyspareunia {difficult & painful sexual intercourse ,pruritus{severe itching },vaginal dryness ,bleeding urinary frequency ,urgency

Skeletal –osteoporosis ,joint and muscle pain ,back pain

Skin and soft tissue -decreased brest size

In thin female it b’come flat and shriveled

In fatty female it b’come flabby and pendulous .

Skin thinning ,loss elasticity

Psychological –mood disturbance ,irritability ,fatigue ,decreased libido ,memory loss

General changes : skin ,weight ,hair {become rough ,dry },voice become deeper due to thickening of vocal cord

Investigations :-increased levels of FSH {greater than 35 iu/l} on day of 3 of cycle {if still cycling }and LH {FSH GREATER THAN LH }

Decreased level of estradiol {normal level of E2 for menstruating women range from 15 to 350 pg /ml .}for postmenopausal women ,normal range -10pg/ml .

Treatment –goal is for individual sx management

Vasomotor instability –HRT{hormonal replacement therapy by oral ,transdermal patches ,vaginal creams ,gels ,implants } –FIRST LINE ,SSRIs –selective serotonin reuptake inhibitors used in antidepressants{venlafaxine} ,gabapentin {partial seizures ,neuropathic pain ,hot flashes etc },propranolol ,clonidine ,acupuncture

Vaginal atrophy –local estrogen ,cream ,vaginal suppository ,ring ,lubricants

Urogenital health –lifestyle changes ,local estrogen replacement ,surgery

Osteoporosis -1000-1500 mg ca OD ,800 -1000 IU VIT .D, WEIGHT BEARING EXERCISE SMOKING CESSATION ,BISPHOSPHONATES ,

DECREASED LIBIDO –VAGINAL LUBRICANT ,ANDROGEN REPLACEMENT ,MANAGE CARDIOVASCULAR RISK FACTORS ,MOOD AND MEMMORY ANTI DEPRESSANT

INCREASED RISK OF BREAST CANCER IS ASSOCIATED WITH ESTROGEN + PROGESTERONE HRT ,BUT NOT ONLY ESTROGEN –ONLY HRT .

Milan Tomic

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