Gynecology Book

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MenopauseAka: Perimenopause

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  1. Symptoms of Perimenopause (lasts 3-8 years)
    1. Disturbance in menstrual pattern
      1. Shorter menstrual interval
      2. Heavier menstrual flow
    2. Hot Flashes (50-75% of women)
    3. Atrophic conditions (responds to Estrogen)
      1. Vaginal Mucosa (Atrophic Vaginitis)
        1. Vaginitis or vaginal Pruritus
        2. Dyspareunia
      2. Urethritis
        1. Dysuria, urgency, or urinary frequency
        2. Recurrent Urinary Tract Infection
    4. Neuropsychological changes
      1. Major Depression
        1. Estrogen Replacement efficacious as Antidepressant
        2. Soares (2001) Arch Gen Psychiatry 58:529
      2. Insomnia
      3. Hippocampus changes
        1. Decreased memory
        2. Decreased learning
        3. Decreased navigation or way finding
    5. Testosterone Deficiency (worse in surgical menopause)
      1. Decreased energy and sense of well being
      2. Decreased sexual desire, arousability, and orgasm
        1. Decreased clitoral sensitivity
        2. Decreased nipple sensitivity
      3. Thinning of pubic hair
  2. Labs
    1. Follicle Stimulating Hormone (FSH)
      1. Not necessary to confirm diagnosis
      2. May be indicated for perimenopausal women age <45
      3. FSH >25 mIU/ml confirms perimenopause or menopause
        1. Measure on any day if patient is not having Menses
        2. Measure on Day 3 of cycle in menstruating women
        3. Measure Day 6-7 of Oral Contraceptive Placebo week
          1. Confirms Birth Control no longer needed
    2. Thyroid Stimulating Hormone (TSH)
      1. Consider for atypical or young presentation
      2. Vasomotor (hot flash) symptoms predominate
    3. Vaginal pH
      1. pH > 4.5 indicates menopause
        1. Women without Vaginitis and not receiving HRT
      2. pH <4.5
        1. Can be used to monitor for adequate HRT response
      3. References
        1. Roy (2004) Am J Obstet Gynecol 190:1272
  3. Diagnosis
    1. Serum FSH level not necessary in age >45 years
    2. Perimenopause: Hot Flashes and irregular Menses
    3. Menopause: Hot Flashes and no Menses for 6 months
  4. Management: Standard Regimens for Menopause
    1. Estrogen Replacement Therapy
      1. Currently being reevaluated due to adverse effects
      2. See alternatives for Vasomotor Symptoms of Menopause
      3. See Cardiac Risk Management
    2. Calcium Supplementation at 1500 mg per day
    3. Vitamin D Supplementation
    4. Osteoporosis Management (as needed)
  5. Management: Perimenopause
    1. Agents
      1. Provera 5-10 mg for 12 days per month
        1. Prevents endometrial hyperplasia
      2. Oral Contraceptives (OCP)
      3. Levonorgestrel IUD (Mirena)
        1. Stops Menstrual Bleeding but risk of atrophy
      4. Sequential Hormone Replacement
    2. Evaluating end of perimenopause for women on OCPs
      1. Identify when to switch to postmenopause management
      2. Obtain Serum FSH on 6th day of OCPs Placebo pills
      3. Menopause suggested by FSH > 30 IU/L
  6. Management: Newer Adjunctive Therapy
    1. Consider Androgen Replacement in Women
      1. Testosterone Replacement in Women
      2. DHEA Replacement in Women
    2. Combination Preparations
      1. E2P4T (Estrogen, Progesterone, Testosterone)
        1. Available from compounding pharmacy
        2. Fax: 931-380-1917
        3. Cost: $15
      2. DHEA-S (see DHEA-S Replacement in Women)
        1. Used with the E2P4T
  7. Alternative Medicine (Variable efficacy)
    1. See Vasomotor Symptoms of Menopause
    2. Phytoestrogens
    3. Dong Quai
    4. Yam extract
    5. Black Cohosh
  8. References
    1. Greenblatt (1972) J Am Geriatr Soc 20:49
    2. Orentreich (1984) J Clin Endocrinol Metab 59:551
    3. Seeman (1997) Am J Psychiatry 154:1641
    4. Shifren (2000) N Engl J Med 343:682
    5. Shuer (2001) CMEA Medicine Lecture, San Diego

Menopause (C0025320)

Definition (MSH)The last menstrual period. Permanent cessation of menses (MENSTRUATION) is usually defined after 6 to 12 months of AMENORRHEA in a woman over 45 years of age. In the United States, menopause generally occurs in women between 48 and 55 years of age.
Definition (CSP)cessation of menstruation in the human female, usually occurring around the age of 50.
Definition (NCI)(MEN-o-pawz) The time of life when a woman's menstrual periods stop permanently. Also called "change of life."
Definition (GO)Cessation of menstruation, occurring in (e.g.) the human female usually around the age of 50. [http://cancerweb.ncl.ac.uk/]
Definition (NCI)The permanent cessation of menses, usually defined by 6 to 12 months of amenorrhea in a woman over 45 years of age.
ConceptsPhysiologic Function (T039)
English"Change of life", Female climacteric, Female climacteric state, Menopausal, Menopausal state, Menopause, The change
Spanishclimaterio femenino, el cambio, estado climaterico femenino, estado menopausico, menopausia
Parent ConceptsReproductive function (C0232896), sex cycle (C0597444), Menopausal syndrome (C0025319), Ovarian Diseases (C0029928), UTERINE/ENDOMETRIAL DISORDERS (C0549623), development of secondary female sexual characteristics (C1160572), menstrual cycle phase (C1818633), Climacteric (C0008943), Reproductive System Process (C1514870), Physiologic States (C1373236), Female genital tract functions (C0567316), Ambiguous concept (C1274012), Duplicate concept (C1274013)
SourcesAOD, CSP, CST, GO, LCH, MEDLINEPLUS, MSH, MTH, NCI, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Perimenopause (C0993589)

Definition (MSH)The transitional period before and after MENOPAUSE. Perimenopausal symptoms are associated with irregular MENSTRUAL CYCLE and widely fluctuated hormone levels. They may appear 6 years before menopause and subside 2 to 5 years after menopause.
ConceptsPhysiologic Function (T039)
EnglishPerimenopause
Parent ConceptsMenopause (C0025320)
SourcesCSP, MEDLINEPLUS, MSH, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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