Menopause resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayeesha Kattubadi, M.B.B.S[2]
Synonyms and keywords:
Overview
This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
Common Causes
- Natural menopause
- Premature ovarian failure or Early menopause
- Surgical menopause
- Chemotherapy and radiation induced menopause
Diagnosis
Shown below is an algorithm summarizing the diagnosis of menopause. [5] [6] [7]
| Presence of Menopausal Symptoms + irregular/absent menstrual periods | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Age | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ≥45 years | 40-45 years | ≤40 years | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Uterus | Rule out other causes like pregnancy, hyperthyroidism, prolactinoma | Rule out medical and surgical causes of amenorrhea/oligomenorrhe | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Absent | Present | Normal | Abnormal | Measure FSH and Estradiol two samples 4-6 weeks apart | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Menopause diagnosed based on symptoms | Irregular periods+ menopausal symptoms | Amenorrhea>12 months ± menopausal symptoms | Amenorrhea > 12 months | Menopause ruled out | FSH elevated Estradiol depressed | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Perimenopause | Menopause | Early menopause | Premature ovarian failure | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of menopause. [8] [9]
| Menopausal symptoms | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Genitourinary syndrome of menopause (vaginal dryness, itching, dyspareunia, urinary incontinence) | Vasomotor symptoms (hot flashes, night sweats) | Sleep problems | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Water based lubricants Ospemifene Vaginal oestrogen | Based on patient preference | Regular exercise, Sleep hygiene, Avoid alcohol and caffeine | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Life style modification | Medical therapy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| -Avoid smoking, caffeine, alcohol -Use of fan, cool bedroom, cool shower -Relaxation exercises | Hormonal replacement therapy | Non-hormonal therapy | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Post hysterectomy status | When hormonal use is contraindicated (History of breast cancer, Venous thromboembolism, Undiagnosed vaginal bleeding, etc. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hysterectomised | Uterus in-situ | Paroxetine(SSRI) Clonidine Gabapentin Clinical hypnosis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Oestrogen alone | Oestrogen+Progesterone | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Do's
- The content in this section is in bullet points.
Don'ts
- Do not use measurements of anti müllerian hormone, inhibin B, estradiol, FSH, LH, testosterone in the diagnosis of menopause in women of age ≥45 years.
- Do not use FSH levels in diagnosing menopause in women <45 years of age who are on oral contraceptives.
- Do not use hormonal replacement therapy in women with high risk for cardiovascular disease, venous thromboembolism, breast cancer.
- Do not recommend use of complimentary medicine treatment options like black cohash, omega-3 fatty acids, red clover, vitamin E due to lack of sufficient data proving its efficacy.
- Do not use ospemifene for vaginal dryness in women with history of breast cancer.
References
- ↑ Rodriguez M, Shoupe D (2015). "Surgical Menopause". Endocrinol Metab Clin North Am. 44 (3): 531–42. doi:10.1016/j.ecl.2015.05.003. PMID 26316241.
- ↑ Secoșan C, Balint O, Pirtea L, Grigoraș D, Bălulescu L, Ilina R (2019). "Surgically Induced Menopause-A Practical Review of Literature". Medicina (Kaunas). 55 (8). doi:10.3390/medicina55080482. PMC 6722518 Check
|pmc=value (help). PMID 31416275. - ↑ Torrealday S, Kodaman P, Pal L (2017). "Premature Ovarian Insufficiency - an update on recent advances in understanding and management". F1000Res. 6: 2069. doi:10.12688/f1000research.11948.1. PMC 5710309. PMID 29225794.
- ↑ Liem GS, Mo FK, Pang E, Suen JJ, Tang NL, Lee KM; et al. (2015). "Chemotherapy-Related Amenorrhea and Menopause in Young Chinese Breast Cancer Patients: Analysis on Incidence, Risk Factors and Serum Hormone Profiles". PLoS One. 10 (10): e0140842. doi:10.1371/journal.pone.0140842. PMC 4613138. PMID 26485568.
- ↑ 5.0 5.1 Stuenkel, Cynthia A.; Davis, Susan R.; Gompel, Anne; Lumsden, Mary Ann; Murad, M. Hassan; Pinkerton, JoAnn V.; Santen, Richard J. (2015). "Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology & Metabolism. 100 (11): 3975–4011. doi:10.1210/jc.2015-2236. ISSN 0021-972X.
- ↑ https://www.nice.org.uk/guidance/ng23/chapter/Recommendations
- ↑ https://www.menopause.org.au/hp/gp-hp-resources/300-diagnosing-menopause
- ↑ "ACOG Releases Clinical Guidelines on Management of Menopausal Symptoms - Practice Guidelines - American Family Physician".
- ↑ "What are the treatments for other symptoms of menopause? | NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development".
- ↑ https://www.nice.org.uk/guidance/ng23/chapter/Recommendations