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Menopause PDF

Menopause is defined as the last menstrual period which occurs after 12 months of amenorrhea. It typically occurs around age 50 due to a decrease in ovarian follicles and estrogen production. Symptoms include hot flashes, mood changes, vaginal dryness, and increased risk of osteoporosis and heart disease due to estrogen deficiency. Hormone therapy can help treat many menopausal symptoms but also has risks, so alternative therapies are also options. Screening after menopause involves regular exams, testing, and mammograms.

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Salim Chahine
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18 views25 pages

Menopause PDF

Menopause is defined as the last menstrual period which occurs after 12 months of amenorrhea. It typically occurs around age 50 due to a decrease in ovarian follicles and estrogen production. Symptoms include hot flashes, mood changes, vaginal dryness, and increased risk of osteoporosis and heart disease due to estrogen deficiency. Hormone therapy can help treat many menopausal symptoms but also has risks, so alternative therapies are also options. Screening after menopause involves regular exams, testing, and mammograms.

Uploaded by

Salim Chahine
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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MENOPAUSE

• MENOPOSIS, the end of the month (MEN) in Greek


(PAUSE),
• Last menstrual bleeding is a retrospective diagnosis made
after 12 months of absence.
• Cover. menopause age 50, (early menopause under 45 years, late
menopause over 55 years)

• Follicle in the ovary decreases, estrogen decreases (20<pg/


ml) (Over 35 yrs regresses, atresia starts, Ö, ÿnh decreases)
• Genetics
• 1-2 million oocytes in YD
• 300 thousand oocytes at puberty

• 35y 25 thousand

follicles • Menopause 1000

follicles • Reproductive; 400-500 ovulation

• FSH-LHartar,E2-androstenedione-inh-B and IGF


decreases by 1
• Climacterium; reproductive period
It starts with the end of the disease and continues until
the old age . Premenopause, postmenopause

• Perimanopause; Covers the mean 2 years before


menopause and the first 1 year after menopause

• Premature menopause; 1% before age 40


• Smoking reduces the age of menopause • As the

number of parity increases, the age of menopause

increases • There is a risk of early menopause due to malnutrition


Estrogen
• Granulosa hc in the ovary, bust gland cortex, fat d hc,
androstenedione and testosterone in the periphery
obtained by aromatization.
• 2 types. Natural, synthetic
• Skin cell, sweat gland, hair follicle, brain, cerebral
cortex, HT-HF also has ER
• Source of O in menopause: testosterone and estrone
• Ted: flushing, vaginal dryness, urinary-emotional
lability, effect on cerebral cortex(serotonin)
• HDL and TG increase, LDL decreases
with O deficiency;

• Vasomotor symptoms; 50-85%; decrease in O; hot


flushing (sudden, localized body temperature setting on the face-
neck-chest decreases), sweating, palpitation, 20%, lasts for 2-5 years.

• Psychological symptoms, mood swings, depression,


insomnia, attention deficit
• Urogenital symptoms: sex steroid R; burning urine,
urgency, vaginal discharge, vaginal lubrication
decreases, dryness, itching, dyspareunia, uterovaginal
prolapse,U.I
climacterium
• Routine examination (pm, usg, svs, biochemistry,
mammography-breast usg)
• HRT

• Abdominal (android) lubrication (hormonal


change); improves with Ö, type2 DM decreases.

• Diet, weight loss (10%), exercise (150min/week)


(stretching), no smoking-alcohol
progestin

• LNG(250mcg), Norethindrone(5mg),
megestrol acetate(5mg): HDL decreases
• Low dose use is safer.
Menopause symptoms
• Hot flush (skin becomes bloody) regresses
with E2 • Night sweats, sleep quality decreases (hypothalamus
tan serotonin secretion
decreases) • Irregular menstrual
periods • Loss of libido (vulvar-clitoral
sensitivity) • Vaginal dryness (mucous thins, glycogen
decreases, vaginal pH increases), dyspareunia • Hair loss,
hairiness, dental probe, CVS hst, abdominal muscle
weakness,, …)
• Urinary incontinence: Parity, difficult delivery,
surgical intervention, spinal cord problem •
bone fractures (femur-vertebra-hand
wrist…); bone formation>destruction up to 30y, bone
mass maximum 25-30yy
osteoporosis

• Osteoporosis; bone mass(strength)(quality+density)


decrease, fracture mg • Trabecular bone
resorption • Total bone mass loss 1.5/year • BMD(X-
Ray dual energy absorbtiometry(DEXA) • T
score;N:>- 1, osteopenia -1and -2.5,OP <-2.5
• HDL: increases with Ö, decreases with MPA-Levanorgestrol

• Ö: inhibits atherosclerosis (; effect on the arterial endothelium


and smooth muscles Ö, p R, platelet
reduces aggregation, inhibits smooth muscle hc proli,
increases PG synthesis with VD, affects lipid-proteins,
cholesterol decreases)

• TGs do not increase when P to Ö is added.

• Do not give HRT to people with heart disease!!


Follow-up in menopause

• Story
• FM
• PM(SVS, TVUSG)
• Breast examination
• LFT, BG, Lipids •
Mammography-breast usg
• BMD,thyroid,CVS,GIS,endometrium
• In the early period, when there are menstrual
irregularity and vasomotor complaints, hormonal
evaluation is made
• FSH,AMH
treatment

• Hormone therapy (P+P)


• SSRI
• Tibolone(synthetic steroid estrogen)(bone,
vagina, climacteric chic, mood-state, sexual effect, breast-
endometrium ineffective)
• Phytoestrogens (does not contain hormones, has
hormone effect) (isoflavone/black cohosh)
• Ca, diet, vit-D
400iu/g, bisphosphonates, SERM (raloxifene), strontium
Ranelate,PTH,calcitonin
estrogens
• CEE 0.625mg,17B
E2(menopause):1-2mg,EE:0.02mg •
Transdermal E2:0.025-0.050mg • Natural
Ö:17BE2,EV,Micronized E2,E3 •
Conjugated E • Synthetic Ö:EE(COC ) •
Oral, parenteral (transdermal, mucosal)
• Ö(TD, vagina, implant, in, sublingual,
injectable)
• parenteral route: no first pass effect from the liver, lipid
profile does not change, no TG absorption,
no loss of DM-HT regulation, no increase in
thrombosis risk , low dose, no gallstones
SERM

• Connects to ER
• E-like effect

• E effect block

• Triphenyl ethylene derivatives: tamoxifen, clomiphene •

Benzothiophene: raloxifene (menopausal treatment) (bone lipid


estrogenic, E antagonist in endometrium)

• Phytoestrogens •

Preference for OP and cholesterol in those who cannot take HT


P treatment indication

• With hysterectomy;
• Endometrium CA
• Endometriosis
• OP risk

• If TG is high
HT side effects

• Vaginal bleeding: atrophy endo bx


• Breast sensitive: fibrocyst
• Mood :P

• Weight gain •

Screening if there is a family history of VTE


HT contraindications
• Definite; endometrium ca, breast ca, liver hst,
thromboembolism, MI, uterine bleeding
• Relative: epilepsy, migraine, HT, familial
lipid elevation, gallbladder hst, uterine myoma
• Giving HRT over 60 years/10 years after menopause
(the risk of coronary hst increases) • Frequency of

VTE in the postmenopausal period is 1- 2/1000/year,


oral administration!!

• Bone strength: density and microstructure; HRT, 50-60y/


menopause-10years effective, exercise, UV, Ca should be
taken.
• It is known that the risk of breast CA does not increase only in E
patients with hysterectomy,
is added . It but
is said
increases
that thewhen
duration
CEE+MPA
of use is
(synthetic)
related
to the dose of administration .

• Postmenopausal bleeding: There is a risk of 1-14% Ca, otherwise


should be considered as endo ca until
proven. Should take endo bx immediately

• 1 year unmet E, endo hyperplasia 20%


increases.

• HT reduces colorectal CA
• Burning, dryness, frequent urination, nocturia, urgency
are common due to vulvavaginal atrophy. Local P(E2/
estriol) is the first choice in treatment.
lubricant/moisturizer
• Increases the risk of urinary incontinence.

• Alternative treatment methods; mineral, vit, herbal,


yoga, breathing therapy, hypnosis,….

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