Menopause: Difference between revisions

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* This may be secondary to hot flashes
* Anxiety and depression may have a negative effect on sleep during this time
* Sleep disturbances can occur in the absence of any other issues listed above<ref>Kravitz HM, Ganz PA, Bromberger J, Powell LH, Sutton-Tyrrell K, Meyer PM. Sleep difficulty in women at midlife: a community survey of sleep and the menopausal transition. Menopause. 2003 Jan 1;10(1):19-28.</ref>
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* Simple, non‐hormonal interventions for sexual dysfunction are often overlooked. Several studies show that education on vaginal lubricants, moisturizers, and dilator use (as needed) can decrease the morbidity of vaginal atrophy.<ref name=":2">Carter J, Goldfrank D, Schover LR. Simple strategies for vaginal health promotion in cancer survivors. The journal of sexual medicine. 2011 Feb 1;8(2):549-59.</ref>
* Simple, non‐hormonal interventions for sexual dysfunction are often overlooked. Several studies show that education on vaginal lubricants, moisturizers, and dilator use (as needed) can decrease the morbidity of vaginal atrophy.<ref name=":2">Carter J, Goldfrank D, Schover LR. Simple strategies for vaginal health promotion in cancer survivors. The journal of sexual medicine. 2011 Feb 1;8(2):549-59.</ref>
* dilators<ref name=":2" />
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Revision as of 21:12, 24 April 2019

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Definition[edit | edit source]

Natural menopause occurs when there is a complete, or near complete, ovarian follicular depletion of a female's ovaries. This results in the end of her menstrual cycle for 12 months, which is retrospectively determined. It occurs at a median age of 51.4 years and menopause before the age of 40 years old is considered abnormal. The months and years leading up to this are called peri-menopause.[1]

Clinical Exam[edit | edit source]

Subjective:

Symptoms of menopause and peri-menopause:[2][3]

Symptoms Information
Hot flashes
  • A hot flash typically begins a sudden sensation of heat in the upper chest, face, and back, often associated with perspiration[4]
  • Occurs in up to 80% of women[4]
  • Hot flashes can begin in the late reproductive years and symptoms become more common through early menopause, late menopause, and early post menopause period[5]
Vaginal dryness
Sexual function
  • Genitourinary syndrome of menopause (GSM) refer to atrophic symptoms women may have in the vulvovaginal and bladder-urethral areas from loss of estrogen that occurs with menopause[6]
  • Vulvovaginal atrophy can cause vaginal dryness, burning, and/or dyspareunia, in menopausal women[7]
Mood symptoms
Sleep disturbances
  • This may be secondary to hot flashes
  • Anxiety and depression may have a negative effect on sleep during this time
  • Sleep disturbances can occur in the absence of any other issues listed above[8]
Joint pain
Cognitive changes
Irregular bleeding or spotting

Longterm consequences of low estrogen

Health Concerns Information
Bone loss
Cardiovascular disease
Dementia
Osteoarthritis
Body composition
Skin changes
Balance

Objective:

Stages of Reproductive Aging Workshop (STRAW) staging system was developed from data from multiple longitudinal cohort studies. This system is considered the gold standard and includes criteria for the reproductive years, the menopausal transition, perimenopause, final menstrual period (FMP), and postmenopause based upon bleeding patterns, endocrine findings, and symptoms. The STRAW system is used mainly in research, however, it may be helpful in the clinical setting for patients and clinicians to assess fertility potential, contraceptive needs, and potential need for hormone therapy.[9]

Stage[9] Signs/Symptoms[9]
Late reproductive years May begin to notice changes in her menstrual cycle (ie. a shorter cycle)
Early menopausal transition This is marked by increased variability in menstrual cycle length
Late menopausal transition Marked by the occurrence of amenorrhea of 60 days or longer

Characterized by increased variability in cycle length, and extreme fluctuations in hormonal levels

Early postmenopause period Corresponds to the end of “perimenopause,” a term still in common usage that means the time around menopause
Late postmenopause period Symptoms of vaginal dryness and urogenital atrophy become increasingly prevalent at this time

Management[edit | edit source]

Physiotherapy

Issue Intervention
Vaginal Dryness and/or Sexual Health
  • Simple, non‐hormonal interventions for sexual dysfunction are often overlooked. Several studies show that education on vaginal lubricants, moisturizers, and dilator use (as needed) can decrease the morbidity of vaginal atrophy.[10]
Bone Loss
  • Exercise also has beneficial effects on bone mass density in premenopausal and postmenopausal women[11]
Balance
  • Exercise to maintain or build

Medical

vaginal estrogen therapy for GSM

Resources[edit | edit source]

American College of Obstetricians and Gynecologists: Menopause Resource Overview

References[edit | edit source]

  1. ↑ The American College of Obstetricians and Gynecologists. Menopause: Resource Overview. Available from https://www.acog.org/Womens-Health/Menopause
  2. ↑ Burger HG. Unpredictable endocrinology of the menopause transition: clinical, diagnostic and management implications. Menopause international. 2011 Dec;17(4):153-4.
  3. ↑ Burger HG, Hale GE, Dennerstein L, Robertson DM. Cycle and hormone changes during perimenopause: the key role of ovarian function. Menopause. 2008 Jul 1;15(4):603-12.
  4. ↑ 4.0 4.1 Thurston RC, Joffe H. Vasomotor symptoms and menopause: findings from the Study of Women's Health across the Nation. Obstetrics and Gynecology Clinics. 2011 Sep 1;38(3):489-501.
  5. ↑ Randolph JF, Sowers M, Bondarenko IV, Gold EB, Greendale GA. The relationship of longitudinal change in reproductive hormones and vasomotor symptoms across the menopausal transition. Fertility and Sterility. 2004 Sep 1;82:S65.
  6. ↑ Portman DJ, Gass ML, Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society. Climacteric. 2014 Oct 1;17(5):557-63.
  7. ↑ Gandhi J, Chen A, Dagur G, Suh Y, Smith N, Cali B, Khan SA. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. American journal of obstetrics and gynecology. 2016 Dec 1;215(6):704-11.
  8. ↑ Kravitz HM, Ganz PA, Bromberger J, Powell LH, Sutton-Tyrrell K, Meyer PM. Sleep difficulty in women at midlife: a community survey of sleep and the menopausal transition. Menopause. 2003 Jan 1;10(1):19-28.
  9. ↑ 9.0 9.1 9.2 Harlow S, Gass M, Hall J, Lobo R, Maki P, Rebar R, Sherman S, Sluss P, de Villiers T. Executive summary of the stages of reproductive aging workshop+ 10. Menopause. 2012 Apr 1;19(4):387-95.
  10. ↑ Carter J, Goldfrank D, Schover LR. Simple strategies for vaginal health promotion in cancer survivors. The journal of sexual medicine. 2011 Feb 1;8(2):549-59.
  11. ↑ Howe TE, Shea B, Dawson LJ, Downie F, Murray A, Ross C, Harbour RT, Caldwell LM, Creed G. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane database of systematic reviews. 2011(7).
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