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Menopause - Coggle Diagram
Menopause
Definition
12 months of amenorrhea following last natural menstrual period
Meopause is a single day, and post-menopausal is the time following the 12 months
Early Menopause
Occurs between age of 40-45
Occurence before age 40: Prematurie ovarian insufficiency, that results in early loss of protective effects of estrogen
Late Menopause
Occurs after age of 55 due to longer exposure of estrogen
Perimenopause
Transition period leading to menopause beginning with altered ovarian hormone production
Lasts 2-8 years, and continues until 1 year after last menstrual period
Assocaited wtih fluctuating hormone levels
Varied symptoms of menopause
Symptom
Hot flashes, night sweats, sleep disturbance, poor memory/concentration,irritability, emotional lability, depression, fatigue, myalgias and athralgias, increased urinary frequecny and urgency, vaginal dryness, diminished sexual drive
Vasomotor Symptoms affect 60%-80% of women
60% experience hot flashes for less than 7 years, hot flashes persist for 15 years or more
Narrowing of thermoneutral zone, small changes in temperature can evoke the regulatory response of sweating or shivering
Risk Factors: Obesity, cigarette smoking, triggers (alcohol, warm ambient environment, hot drinks)
Urogential Atrophy
First sign of menopasue and progressive with time
Experiences: Discomfort, dyspareunion, Bleeding, post-coital bleeding, urinary frequency, urinary incontinence
Treatment
Treatment
Hormone Replacement Therapy
Contraindications
Hormone dependent cancers, Active/Recent arterial thromboembolic disease, venous thromboemblosim, Severe active liver disease, Uninvestigated abnormal uterine bleeding
Womens Health Initiative: Do not use these medications in elderly asymptomatic women
Increases relief of hot flashes to increase QOL, Improvement of vaginal dryness, and preventing osteoporosis
For Vasomotor Symptoms
Lifestyle modifications, body temperature, regular exercise, weight management, smoking cessation, avoiding known triggers
HCP should offer HT as most effective therapy
Progestins alone or low dose roal contraceptives can be offered during transitiion
Nonhormonal prescription therapies: Certain antidepressant agents, gabapentin, clonidine, bellergal
Cardioprotetive in those who exprience premature ovarian removal + Premature ovarian failure
Critical Window
Use of HT at onset can be cardioprotective whereas later use can cause adverse events
Use in older women with CAD may increase incidence of coronary artery events
VTE risk
Risk is greatest in first year of use
Risk is reduced with lower doses and transdermal estrogen
Stroke Risk
Risk factors should be addressed, use lowest effective dose
Breast cancer Risk
Risk Factors
Lack of exercise, gaining weight, alcohol consumption
Lifetime exposure: Linked to hormone receptor positive breast cancer
Bio-identical Hormones
Custom compounded formulations, such as 17-b estradiol, or progesterone capsules
Not recommended
Rolutes of Delivery
Oral Restrogen
Drawbacks
Raises fibrinogen and other coagulation factors, CRP, increased TG, increased sex-hormone binding globulin
Transdermal
Does not have negative effects of gel or patch
Specific HT
17-beta estradiol
Restoration of the bio-identical hormone
Conjugated equine estrogen:
Composed of more than 10 estrogens largest compoentn being estrone
Progestins
Naturally occuring agent that is bioidentical
Estrogen
Lowest dose of estrogen alleviates symptoms
Symptom relief is often a better indicator
Progesterone
Micronized progesterone that is a cream not as well absorbed
Health Risks
CV disease, Osteoporosis, Colorectal cancer, QOL Issues (vasomotor, sexual concerns, depression, cognitive decline)
CVD Risk factors
Central adiposity, glucose intolerance, dyslipidemia, endothelial dysfunction
Main effect of Estrogen deficiency on lipid profile
Decrease in HDL, Increase in LDL, Increased plaque development, and decrease ability to dilate
Osteoporosis
Skeletal disorder characterized by compromised bone strength predisposing a person to increased fractures
May lead to back pain, humped back, hip,spine,wrist fractures
Prevention
Calcium: Essential mineral for good money health, therapy alone is insufficient for high high risk fractures
Vitamin D: Important for maintaining good bone health
Excercise and Balance Training
Improved cooridnation, better banace, greater strength
Less chance of falling, less fractures, less damage from fall
Investigations
Physical Exam
BP, Weight, BMI, Cardiac/Resp exam, breast exam, Abdo exam, PAP and pelvic exam (look for pelvic masses, signs of vulvo-vaginal atrophy
Labs
Hormonal Profile: FSH,LH, E2, Fasting lipids/glucose, Pelvic US, Mammogram, BMD