MENOPAUSEMENOPAUSE

DR. AMEL EL-SAYED, FRCSCDR. AMEL EL-SAYED, FRCSCAssistant Professor & Assistant Professor &

ConsultantConsultantKing Saud UniversityKing Saud University

King Khalid University King Khalid University HospitalHospital

Definition:Definition:Complete cessation of menstruation Complete cessation of menstruation for a complete year. The average for a complete year. The average age is 51 years.age is 51 years.

Perinmenopause:Perinmenopause:It is a 2 -3 year period of time before It is a 2 -3 year period of time before the actual onset of menopause, the actual onset of menopause, when cycles start to show different when cycles start to show different forms of irregularityforms of irregularity

Hormonal Changes in the Hormonal Changes in the PerimenopausePerimenopause

1111 Estradiol levelEstradiol level2.2. Gradual Gradual in FSH level in FSH level3.3. Delayed Delayed in LH level in LH level

This is due to the This is due to the performance of the performance of the remaining follicles.remaining follicles.

Despite these changes occasional Despite these changes occasional ovulation is there, and the risk of ovulation is there, and the risk of unplanned pregnancy still exists.unplanned pregnancy still exists.

Hormonal Changes of Hormonal Changes of MenopauseMenopause

1.1. Persistent Persistent of FSH levels of FSH levels2.2. Persistent Persistent of LH levels of LH levels1111 Production of ovarian testosteroneProduction of ovarian testosterone4.4. Circulating estradiol is mainly derived Circulating estradiol is mainly derived

from peripheral conversion of estrone from peripheral conversion of estrone which is derived from androsten dionewhich is derived from androsten dioneThis estradiol may be sufficient to This estradiol may be sufficient to sustain breast and other estrogen sustain breast and other estrogen stimulated surfaces e.g. vagina, urethrastimulated surfaces e.g. vagina, urethra

Clinical Features of Menopause:Clinical Features of Menopause:

1.1. Cessation of menstruationCessation of menstruation

2.2. Vasomotor instability (hot flushes + sweats)Vasomotor instability (hot flushes + sweats)

3.3. Physiological symptoms: Anxiety, Physiological symptoms: Anxiety, tension tension depression, irritabilitydepression, irritability

4.4. Sleep disturbanceSleep disturbance

5.5. Headaches, myalgia and changes in libidoHeadaches, myalgia and changes in libido

6.6. Atrophic changes: Vagina, urethra, vulva, general skin Atrophic changes: Vagina, urethra, vulva, general skin atrophy and genital prolapseatrophy and genital prolapse

7.7. Urinary difficulties: Urgency, abacterial urethritis and Urinary difficulties: Urgency, abacterial urethritis and cystitis, incontinencecystitis, incontinence

8.8. Health problems the most important of which are:Health problems the most important of which are:

a.a. Fractures 2 Fractures 20 0 to osteoporosisto osteoporosis

b. Cardiovascular diseaseb. Cardiovascular disease

c. DUB, endometrial hyperplasia and endometrial c. DUB, endometrial hyperplasia and endometrial carcinomacarcinoma

Risk factors for the Risk factors for the manifestations of manifestations of Menopausal Symptoms:Menopausal Symptoms:

1.1. Race: White race is more prone than Race: White race is more prone than the black race.the black race.

2.2. Built: Thin built is more prone than Built: Thin built is more prone than heavy weight. heavy weight.

3.3. Cigarette Smoking: Smokers are more Cigarette Smoking: Smokers are more prone than non smokers.prone than non smokers.

4.4. Exercise: Less prominent symptoms Exercise: Less prominent symptoms with regular exercise.with regular exercise.

Management of the Menopausal Management of the Menopausal Patient:Patient:

1.1. Diet: A healthy diet with 1000mg of ca Diet: A healthy diet with 1000mg of ca supplement is needed. Vit D should be added for supplement is needed. Vit D should be added for women who are not getting enough sun women who are not getting enough sun exposure.exposure.

2.2. Exercise: Regular exercise 3 times a week for at Exercise: Regular exercise 3 times a week for at least 30 minutes is recommended.least 30 minutes is recommended.

3.3. Stop Smoking: If current smoker.Stop Smoking: If current smoker.

4.4. HRT: Combined estrogen + progestin for HRT: Combined estrogen + progestin for patients who still have their uterus.patients who still have their uterus.

Estrogen alone for patients who had a Estrogen alone for patients who had a hysterectomyhysterectomy

Given in a cyclic or continuous fashion Given in a cyclic or continuous fashion

0.625 mg of estrogen day 1 – 21 0.625 mg of estrogen day 1 – 21

5-10 mg of progestin x 13 days5-10 mg of progestin x 13 days

O.RO.R

0.625 mg of estrogen daily0.625 mg of estrogen daily

+ 2.5 mg of progestin daily+ 2.5 mg of progestin daily

Estrogen patches can be used but the oral Estrogen patches can be used but the oral route was proven to be superiorroute was proven to be superior

5.5. Monitor: BP, lipid profile and blood sugarMonitor: BP, lipid profile and blood sugar

6.6. Any abnormal PV bleeding should be Any abnormal PV bleeding should be reported and investigatedreported and investigated

7.7. Calcitonin for patients with underlying Calcitonin for patients with underlying parathyroid pathologyparathyroid pathology

8.8. Drugs for Rx of oesteoprosisDrugs for Rx of oesteoprosis

9.9. Bone densityBone density

10.10. Regular breast examsRegular breast exams

If HRT is contraindicated other option for If HRT is contraindicated other option for symptom control can be used eg symptom control can be used eg clonidineclonidine

Arguments about HRTArguments about HRT Breast cancer risk !Breast cancer risk !

Early MenopauseEarly Menopause Around the age of 40 yearsAround the age of 40 years More severe symptomsMore severe symptoms Requires higher doses of HRTRequires higher doses of HRT

Iatrogenic menopause Iatrogenic menopause Surgery Surgery

RadiationRadiation