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    Menopause: in A Nutshell

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    Dimitrios Papadopoulos
    Menopause is the permanent end of menstrual periods and fertility. It results from loss of ovarian sensitivity to hormones and decreased estrogen and progesterone levels. Symptoms include hot flashes, night sweats, vaginal dryness, and mood changes. Menopause is diagnosed if periods have stopped for 12 consecutive months and FSH levels are elevated. Treatment focuses on lifestyle modifications and hormone therapy to manage symptoms, though hormone therapy carries health risks.

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    Menopause: in A Nutshell

    Uploaded by

    Dimitrios Papadopoulos
    35 views3 pages
    Menopause is the permanent end of menstrual periods and fertility. It results from loss of ovarian sensitivity to hormones and decreased estrogen and progesterone levels. Symptoms include hot flashes, night sweats, vaginal dryness, and mood changes. Menopause is diagnosed if periods have stopped for 12 consecutive months and FSH levels are elevated. Treatment focuses on lifestyle modifications and hormone therapy to manage symptoms, though hormone therapy carries health risks.

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    Menopause

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    Menopause is the permanent end of menstrual periods and fertility. It results from loss of ovarian sensitivity to hormones and decreased estrogen and progesterone levels. Symptoms include hot flashes, night sweats, vaginal dryness, and mood changes. Menopause is diagnosed if periods have stopped for 12 consecutive months and FSH levels are elevated. Treatment focuses on lifestyle modifications and hormone therapy to manage symptoms, though hormone therapy carries health risks.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    35 views3 pages

    Menopause: in A Nutshell

    Uploaded by

    Dimitrios Papadopoulos
    Menopause is the permanent end of menstrual periods and fertility. It results from loss of ovarian sensitivity to hormones and decreased estrogen and progesterone levels. Symptoms include hot flashes, night sweats, vaginal dryness, and mood changes. Menopause is diagnosed if periods have stopped for 12 consecutive months and FSH levels are elevated. Treatment focuses on lifestyle modifications and hormone therapy to manage symptoms, though hormone therapy carries health risks.

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    Gynecology Notes – Papadopoulos DAF

    Menopause

    In a Nutshell:

    A. Menopause is the permanent end of menstrual periods and thus of fertility (amenorrhea)

    B. Manifestations may include hot flushes and vulvovaginal atrophy

    C. Diagnosis is clinical: absence of menses for 1 year

    D. Manifestations may be treated (eg, with lifestyle modification, complementary and


    alternative medicine, and/or hormone therapy).

    A. Physiology

    Menopause results from loss of ovarian sensitivity to gonadotropin stimulation (LH +


    FSH)

    1. Anovulatory cycles + LH surge failure

    2. Less follicles and more Resistant follicles

    3. FSH and LH levels increase => Stromal cells of Ovary stimulation => Increase in Estrone

    4. 4 year Perimenopausal Period (2 before and 2 after) – Estradiol decline due to follicle
    failure – Main estrogen is Estrone coming from by the aromatization of androgens
    (androstenedione) in the ovarian stroma + estrogen production in extragonadal sites
    (adipose tissue, muscle, liver, bone, bone marrow, fibroblasts, and hair roots)
    (peripheral aromatization of androstenedione produced by adrenal glands)

    5. Decreased estradiol + progesterone

    6. A shorter menstrual cycle (< 25 days) is the most common change in menstrual cyclicity
    that occurs during the MT (menopausal transition) in women who continue to be
    ovulatory – shorter follicular phase with 14 day constant luteal phase

    B. Symptoms and Signs

    1. Changes in the menstrual cycle: A persistent difference in consecutive menstrual cycle


    length of ≥ 7 days defines early menopausal transition. Skipping ≥ 2 cycles defines late
    menopausal transition.

    The marked fluctuations in estrogen levels may contribute to other perimenopausal symptoms
    and signs such as

     Breast tenderness
     Changes in menstrual flow
    Gynecology Notes – Papadopoulos DAF

     Moodiness
     Exacerbation of menstrual migraines

    Symptoms can last from 6 mo to > 10 yr and range from nonexistent to severe.

    2. Vasomotor

    Hot flushes (hot flashes, night sweats) on skin, especially of the face, head, and neck, may
    become red and warm. The episodic flush, which may last from 30 sec to 5 min, may be
    followed by chills. Flushes may manifest during the night as night sweats. Reason hypothalamic.

    3. Vaginal

    These symptoms include dryness, dyspareunia, and occasionally irritation and itching

    4. Vulvovaginal atrophy

    5. Genitourinary syndrome of menopause: eg. frequent UTIs

    6. Neuropsychiatric: mood, insomnia etc

    C. Diagnosis

    1. Age of patient must be considered – 45-48 years is the normal symptoms starting age

    2. Confirmation comes after 12 months of amenorrhea

    3. Increased FSH levels measured in 2-3 months intervals

    4. Vulvovaginal atrophy + Menopausal symptoms confirm the diagnosis

    D. Treatment

    A. Lifestyle

    1. Cool environment

    2. Avoid a lot of Light

    3. Vaginal lubrication + Sexual intercourse

    4. Hormonal Th ( Estrogen + Progestin ) : Increase risk of Coronary events, cancers plus


    other disorders esp estrogen

    They must be used only symptomatically and low dosage ( Forms: per os, transdermal,
    cream, vaginal tablets etc. )

    Progesterone for hot flushes

    Menopause Page 2 of 3
    Gynecology Notes – Papadopoulos DAF

    Estrogen more potent for hot flushes and for vaginal dryness and atrophy + anti -
    Osteoporosis

    5. Risks and adverse effects

    Risks with estrogen therapy or combined estrogen /progestin therapy include

     Endometrial cancer, mainly if women who have a uterus take estrogen without a
    progestin
     Deep vein thrombosis
     Pulmonary embolism
     Stroke
     Breast cancer
     Gallbladder disease
     Stress urinary incontinence

    Menopause Page 3 of 3

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