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Menopause is the time in a womans life when her menstrual period stops. It is also called the the change of life. Menopause is a natural biological process that affects each woman differently. It involves a series of changes that happen in a womans body as early as the age of 40 and can last well into her fifties. Perimenopause is the time when women begin to feel the changes of menopause, and may last for several years. Women are post-menopause when they have not had a period for 12 months.
Pathophysiology of Ovulation
FSH (Follicle Stimulating Hormone) tells the ovary to recruit eggs Estrogen is made by the developing eggs
LH (Luteinizing hormone) peaks at midcycle (with estrogen and FSH) resulting in ovulation Post-ovulation, the corpus luteum makes progesterone until lack of pregnancy results in lowered progesterone and menses
Pathophysiology of Menopause
Fewer and fewer follicles are recruited until no follicles develop at all FSH and LH levels become persistantly Elevated
Symptoms of menopause
Every woman experiences menopause in a different way at different times. Some women have very few symptoms, however most women experience some of these physical and emotional changes:
Hot Flashes
Also called hot flushes
or vasomotor events Sudden onset of feeling of intense heat with reddening of face/chest/head skin followed by profuse perspiration Lasts a few seconds - several minutes Frequency is variable - from one per week to several per hour - changes as woman goes through menopause Cause sleep disturbances - may be the etiology of emotional liability in menopause Triggered by stress Embarrassing - happens when women at peak of careers, causes feeling of loss of control
Irregular Cycles
90%
of women have irregular cycles prior to cessation of menses Cycle length shortens, as short as 21 days, followed by skipped periods Occasionally see longer cycle length Flow may be lighter or heavier When to Worry If bleeding closer than every 21 days If bleeding lasts longer than 10 days If bleeding heavy enough to soak a maxipad in 1 hour or less for several hours in a row If any of the above, the patient needs further evaluation
What to do:
EMB (endometrial biopsy)
D&C (rare now) Ultrasound evaluation of uterus with possible saline infused sonohysterogram (SIS) Hormonal treatments such as progesterone, GnRH agonists Surgical treatments such as endometrial ablation or hysterectomy
Vaginal Dryness
Woman often describes dryness or irritation Due to atrophy of mucosal surfaces Causes vaginitis, pruritus, dyspareunia, stenosis of vaginal opening and incontinence Symptoms vary with sexual activity, size of vaginal opening prior to menopause, patient tolerance. Many patients with atrophic appearing vaginas are asymptomatic