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?????