Gynecology [MENOPAUSE]

Introduction
Menopause is defined as the period 1 year after the cessation of
menstruation. Perimenopause is the same thing as menopausal Be aware of, but DON’T memorize the STRAW report, which
transition and refers to the time period from the onset of is a complicated description and categorization of the
menstrual irregularity to the initiation of menopause. On average, process of the menopause transition.
this happens at 51 years of age, but can happen at any time before
or after.

Premature ovarian failure has the same consequence of

menopause, but occurs at an age <40. What You Care About What You Do
Contraception Infertile, sorry
What to look for and what to do Menstrual Irregularities Give it time
The loss of estrogen leads to a number of consequences. Vaginal Atrophy Estrogen Cream
Regarding ovulation, pregnancy becomes impossible. And with Hot Flashes Venlafaxine
ovarian cycles, bleeding cycles stop. During menopause Osteoporosis prophylaxis Vit D3 + Ca
transition, dysfunctional uterine bleeding is normal. Osteoporosis screening Dexa Scan @ 65
Osteoporosis treatment Bisphosphonates
Vaginal atrophy results from lack of estrogen. This is the most
common cause of post-menopausal bleeding. Lubricants during Hormone replacement ↑ cancer risk, don’t do it
sex and estrogen creams can be used. Therapy

Hot Flashes (also called Hot Flushes) are symptomatic only. Heat
intolerance, sweating, and mood changes are variable and can be
debilitating. Phytoestrogens do NOT work. Soy products do NOT
work. SSRIs, specifically venlafaxine, can be used to control
symptoms. HRT has an increased risk of endometrial cancer
and should be avoided.

Post-menopausal women also lose the bone-protective effects of

estrogen; they should be placed on Vit D3 + Calcium
supplementation. Dexa scans at 65 are part of normal screening.
If diagnosed with osteoporosis, bisphosphonates are used. If Vit
D deficiency is diagnosed, use Vit D2 50,000 units weekly.

Making the Diagnosis

DO NOT GET ANY TESTS OR IMAGING

GnRH is released in a pulsatile fashion. This pulsatility induces

release of FSH. FSH then stimulates folliculogenesis of the Ovarian failure hormones:
ovaries and estrogen is released. As the ovaries fail, the feedback
inhibition on GnRh and FSH fails, so levels soar. Estrogen fails ↑↑↑ FSH
to be produced and levels fall. Thus, while it should not be ↑↑↑ FSH / LH Ratio (LH does not rise)
performed in a woman who in the age group expectant of ↓ Estrogen
menopause, an elevated FSH is consistent with ovarian failure. It
should be considered in a woman with premature ovarian failure
to ensure the diagnosis.

The diagnosis can be made with age-appropriate symptoms and

physical exam. There’s no need to document ovarian failure.

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