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Definition
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Adult-onset of progressive failure of ovarian function |
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The median age of menopause is 50 years old, although it may
occur earlier for smokers.
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Defined as absence of menses for 1 year.
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Symptoms
(due to the fall in estrogen)
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Irregular, shortening or cessation of menstrual cycle
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Vasomotor instability -- hot flashes ( Usually subsides 2 to 5
years post-menopause)
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Osteoporosis ( Bone loss at 1 to 2% per year post-menopause)
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Dementia and loss of cognitive function
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Depression, Mood Alteration and Irritability
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Cardiovascular disease with increased risk of atherosclerosis and myocardial
infarction
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Vaginal atrophy and dryness with associated pain during intercourse and
decreased libido.
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Diagnosis
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FSH
is a key lab test for diagnosis of menopause
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Decreased ovarian function as well as a decreased inhibin =
increased FSH levels.
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Diminished ovarian function = FSH> 10-12 mIU/ml
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True Menopause = FSH >40 mIU/ml
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Other baseline studies include pap smear, mammography, bone density
determinations, endometrial assessment and pelvic ultrasound.
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If
patient has increased levels of FSH and estradiol is <30
pg/ml then start hormone replacement therapy.
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Treatment
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Treatment as well as preventive care is with hormone replacement therapy.
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Estrogen therapy can eliminate symptoms, however it associated with an
increased risk of endometrial cancer.
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Progesterone opposes the endometrial hyperplasia and therefore optimize the
benefit:risk ratio of estrogen therapy.
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Remember, every woman with an intact uterus who decides to
receive hormone therapy is required to have an endometrial sampling
before initiation of the treatment. Thereafter an endometrial sample
should be taken annually or when abnormal uterine bleeding occurs.
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OR
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Vaginal probe ultrasound
may be used to screen for risk of
endometrial cancer if the patient refuses to have an
endometrial sampling done. (There is a high risk if the endometrial
thickness is > 5mm).
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Hormone Replacement Therapy(HRT):
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It is and elective form of preventive medicine.
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Should initiate therapy before symptoms appear: DO NOT
WAIT
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Goal
is to prescribe estrogen dosage sufficient to alleviate symptoms,
prevent bone loss, dementia and decrease the risk of cardiovascular disease.
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35 to 50% decreased risk of arteriosclerotic cardiovascular disease
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Increased HDL, Decreased LDL, Decreased total
cholesterol |
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Increased Nitric oxide, Increased prostacyclin, Decreased serum
fibrinogen
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50% decreased risk of alzheimer’s disease
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Decreased risk of diabetes by a factor of 5
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