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menopause - Coggle Diagram

- - - - comorbidities
        
        Hypothyroidism: Monitor thyroid-stimulating hormone (TSH)
        levels regularly to ensure remains within the acceptable range,
        dose of Levothyroxine may need to be increased
        
        For women with co-morbidities, offer hormonal, non-hormonal, or
        non-drug treatment options depending on the risks, benefits,
        adverse effects, and contraindications. If there is any uncertainty
        about appropriate management, seek specialist advice from a
        healthcare professional with expertise in menopause or refer to
        the relevant specialist team.
        
        Breast cancer: Stop systemic hormone replacement in those who
        are diagnosed with breast cancer. Do not routinely offer HRT to
        those with a history of breast cancer.
        
        Venous thromboembolism: Consider use of transdermal and than
        oral HRT
        
        Cardiovascular disease: Manage CVD risks prior to commencing
        HRT
        Type 2 Diabetes: Consider use after taking other co-morbidities
        into consideration
- - - - Suspect in women <40 years (not taking combined hormonal
        contraception) with:
        Menopause symptoms including no or infrequent periods
        Do not routinely perform a pelvic exam
        Elevated serum follicle-stimulating hormone (FSH) level on
        two blood samples taken 4 - 6 weeks apart
    - - differential diagnosis
        
        irregular vaginal bleeding
        
        hot flushes: endocrine causes such as; tumour, excess alcohol, dumping syndrome, anxiety and panic disorder, TB and drugs
        
        secondary amenorrhoea
        
        other symptoms such as urinary incontinence mood changes, sleep disturbances, cognitive impairment, loos of libido, muscle and joint pain, skin changes and weight gain may all be caused by an other condition
  - - - cognitive impairment and mood disorders
      - urogenital symptoms -vulvovaginal
        irritation, discomfort, burning, itching, dryness, dyspareunia,
        reduced libido, dysuria, urinary frequency and urgency and
        recurrent lower urinary tract infections. Urogenital atrophy
        may appear for the first time more than 10 years after last
        menstrual period and dryness increasing in severity over
      - other symptoms associatedHot flushes/night sweats (vasomotor symptoms): sudden
        heat in upper body, spreads up and down. Typically lasting
        2-4 minutes. Can be associated with sweating, palpitations
        or anxiety.
      - alter sex function -vaginal dryness causing
        dyspareunia, loss of sexual desire and libido due to declining
        hormone levels, low mood, loss of confidence, negative self-beliefs about reproductive status, altered self-image
      - Suspect perimenopause: initial change to menstruation
        pattern (shortening or lengthen), change to menstrual blood
        loss (common to increase
      - sleep disturbance - Hot flushes, night sweats, mood
        disorders, primary sleep disorders. Chronically disturbed
        sleep can lead to fatigue, irritability, difficulties with short term memory and concentration.
      - other symptoms include - joint and muscle pain, headaches, fatigue, lack of ovarian hormone production
      - investigations: do no routinely use blood tests such as ESH to DX perimenopause or menopause in a healthy women over the age of 45 years. DX with clinical presentation/symptoms without lab tests
      - consider FSH meausrements when the person is taking combines pill, and are ageed over over 45 years with atypical symptoms, between 40-45 years with symptoms or younger than 40 years with suspected POI
      - do not routinely perform a pelvic examination to DX menopause