Scribd Logo
Upload

Welcome to Scribd!

  • 59 views

    20 Perimenopause & Menopause

    Uploaded by

    Girum Solomon
    This document discusses menopause and hormone replacement therapy. It defines menopause and perimenopause, describes the endocrinologic and organ changes that occur, and lists common clinical manifestations like vasomotor symptoms and urogenital changes. It also outlines indications for hormone replacement therapy including relief of menopausal symptoms and prevention of osteoporosis, and notes some advantages and complications of HRT.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd

    20 Perimenopause & Menopause

    Uploaded by

    Girum Solomon
    59 views14 pages
    This document discusses menopause and hormone replacement therapy. It defines menopause and perimenopause, describes the endocrinologic and organ changes that occur, and lists common clinical manifestations like vasomotor symptoms and urogenital changes. It also outlines indications for hormone replacement therapy including relief of menopausal symptoms and prevention of osteoporosis, and notes some advantages and complications of HRT.

    Original Description:

    perimenopause

    Copyright

    © © All Rights Reserved

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document discusses menopause and hormone replacement therapy. It defines menopause and perimenopause, describes the endocrinologic and organ changes that occur, and lists common clinical manifestations like vasomotor symptoms and urogenital changes. It also outlines indications for hormone replacement therapy including relief of menopausal symptoms and prevention of osteoporosis, and notes some advantages and complications of HRT.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    59 views14 pages

    20 Perimenopause & Menopause

    Uploaded by

    Girum Solomon
    This document discusses menopause and hormone replacement therapy. It defines menopause and perimenopause, describes the endocrinologic and organ changes that occur, and lists common clinical manifestations like vasomotor symptoms and urogenital changes. It also outlines indications for hormone replacement therapy including relief of menopausal symptoms and prevention of osteoporosis, and notes some advantages and complications of HRT.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 14

    Perimenopause &

    menopause

    Birhanu Sendek, MD+


    July, 2009
    Session objectives
     Define menopause
     Describe some physiologic changes
    related to menopause
     Describe clinical features of menopause
     Describe indications of HRT
     List complications of HRT
    Menopause
     Menopause: Defined clinically as 12 months of
    amenorrhea in women over age 45 years in
    the absence of biological or physiological
    causes.
     Perimenopause: around menopause i.e.
    begins at stage -2 of menopausal transition &
    ends after 12 months from the last menstrual
    period.
     Post menopause: Stage +1 (early) i.e. the
    first five years after last menstrual period
    Menopause
     Premature ovarian failure: Menopause
    occurring prior to age 40 years
     Late menopause: if menopause occurs
    after age 55 years.
     The STRAW staging system is now used to
    define the stages of the menopausal
    transition and post menopause
    Epidemiology
     The average age at menopause is
    approximately 51 years.
     Factors that affect age at menopause:
    1. History of smoking
    2. Nulliparous & regular cycles
    3. Family history of early menopause
    4. Type 1 DM & galactose consumption
    5. The presence of a variant of form galactose-
    1-phosphate uridyl transferase
    6. Shorter cycle length during adolescence
    Endocrinologic changes
     Perimenopause /Menopausal transition
    -Early
    ↑FSH/ ↓inhibinB /N,↑estradiol /N-LH
    -Late menopausal transition
    ↑FSH/ ↓ inhibin A,B / ↓ estradiol
     Menopause/post Menopause
    FSH(20×) / LH(3×)
    Organ changes
     Uterus: 1: 1 ration
     Ovary: shrinks & white
     Vagina & vulva
     Breasts
     Bone
     Bladder & urethra
    Clinical manifestations
     Bleeding patterns: oligomenorrhea with
    periods of DUB followed by amenorrhea
     Vasomotor symptoms: hot flush, affects
    70% in some cultures &only 20% need
    help. It is self limited and usually
    resolves 1-5 years after menopause
     Sleep disturbance: primary sleep
    disorder or arousal problem
    Clinical features…
     Genitourinary:
    1. Vaginal dryness: atrophic vaginitis
    2. Sexual dysfunction:
    3. Vaginal dryness & dyspareunia
    4. Other urinary symptoms: include atrophic
    urethritis, diminished urethral mucosa,
    incontinence, & recurrent UTI
     Depression: association between
    menopausal transition & depression.
    Clinical features…
     Skin changes: collagen content of the skin &
    bone decreases
     Long term issues:
    1. Osteoporosis: bone loss occurs prior to
    menopause. Approximately 1.8-2.3% bone
    loss in the spine & 1-1.4 % bone loss in the
    hip
    2. Cardiovascular disease
    3. Dementia
    HRT
    Indications:
     Estrogen deficiency symptoms:

    1. Vaginal dryness &dyspareunia

    2. Vasomotor symptoms

     Osteoporosis

     Premature ovarian failure

     Surgical menopause
    HRT
     In HRT, consider the following:
    1. Estrogen/ combined regimen
    2. Non-medical therapy
    3. Alternate treatment options
    4. Shorten the duration of treatment
    5. Screening of patients for
    contraindications of HRT.
    Advantages of HRT
     Relief of menopausal symptoms
     Prevention of osteoporosis
     Keep skin & mucosal texture
     Prevention of cardiovascular
    diseases?????

    You might also like