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MENOPAUSE
Menopausal Transition
Initial phase
1. Irregular cycles
2. HOT FLUSHES
3. Insomnia, Mood swings, night sweats
Late Phase: Osteoporosis
Symptomatic: 50%
In 90s: all must be treated until she dies
But now according to WHI (Womens Health
Initiative) ONLY treat the symptomatic menopause
with duration no more than 5 years because after
time there is presence of cardiovascular problems.
Try to treat symptomatic patients with shortest
possible time.
PELVIC EXAM:
Atrophic vagina:
Normal menstruating woman: (+) Rugae
In menopause: Loss of Rugae
Work ups
Breast: Mammography
TVS: Uterus
Check for Endometrial thickness
IF thick: Do not give E
DX:
1. CHMI
2. Gonadotropin FSH followed by LH
3. E (measured form: Estradiol)
4. Inhibin B - More sensitive test:
It inhibits the secretion of GnRH & eventually
the gonadotropin so with Inhibin, it will lead
to continuous FSH
TX:
E + P (HRT)
1. Used in patient has intact uterus because E alone
may result to a hyperplastic endometrium
2. Risk for Endometrial CA
CASE 10
systemically absorbed.
52 year old G3P3 (3003) complains of pain during sexual contact for the past 4 mos. She also notes night sweats & difficulty
sleeping. LMP March 2012, PPE: Breasts: Symmetrical, no mass, no tenderness; Speculum examination: Vaginal mucosa is
pale pink, smooth; Cervix pale pink, smooth, no discharge. IE: cervix is firm, short, flushed to the vaginal walls; Uterus is small;
Adnexa no mass nor tenderness
CASE:
TX: Estrogen Oral/ Topical/ Patch
Bear in mind all the effects of E on the body, not just to
offset the symptoms of menopause.
If you are going to give E, it will be termed as ET:
Estrogen Therapy. (Past: ERT Estrogen Replacement
Therapy)
TX Osteopenia or Osteoporosis:
Alendronate, Biphosphanate, NOT HT
Cause:
Steroid Intake
Other Symptoms:
BMI
Dyspareunia
POP
-2.5 (osteoporosis)
N: Osteopenia
Z score: Age
Laboratory Test
FSH
AMH
E + P (several months)
Low dose E
E+P
(+) Uterus
Menstruate
Local
Topical Cream
OSTEOPOROSIS
Agonist: Bone
Ca Supplements/ Vitamin D
If patient is menopausal:
Thinned endometrium
Mood swings
TX: Statin
Osteoporosis
Measurement: DEXA
o T score: young healthy adult
o Z score: compared to age group
o Normal T score: C1 neg N abn
TX:
Cancer: