absence of menstrual periods for at least 6 months in a woman over 40
menopause
more rapid oocyte depletion and hypoestrogenism starting age 37
perimenopause
time between onset of irregular AND permanent cessation of menses
perimenopause
premature menopause before age 40
premature ovarian failure
hormonal changes in perimenopause
decreased INHIBIN and increased FSH
hormonal changes in established menopause
marked reduction in ESTRADIOL (plus dec inhibin and inc FSH too)
first symptom of menopause
menstrual irregularities
thin lola vs fat lola during menopause - anong difference
thin lola prone to DRYNESS; fat lola prone to hyperplasia and BLEEDING
how to diagnose menopause
use signs and symptoms and physical exam
treatment for asymptomatic women
NONE
2 main indications of hormonal therapy
for symptomatic women AND to prevent osteoporosis and heart disease
most effective treatment for vasomotor symptoms
LOW DOSE hormone therapy (ex. 0.3 mg CEE)
route for those with liver problems
transdermal (0.25 mg transdermal estradiol)
hormonal treatment for vulvovaginal symptoms
HRT including tibolone
first line tx for mood disorders
not HRT but anti-depressants
explain the “window of opportunity” concept
HT may be cardioprotective if started around the time of menopause and continued long-term
risk for ________ (disease) is INCREASED in women on HRT
venous thromboembolism
for women over 60 with rish of osteoporosis, must take ___
raloxifene, biphosphonates or strontium ranelate.. AND .8-1g calcium and 800 IU vitamin D
differentiate advantages/disadvantages of two types of HRT regimens
CYCLIC has predicatble and controlled bleeding, CONTINUOUS has good compliance but irregular bleeding
hormonal therapy for vasomotor sx, sexual well-bein, vulvovaginal symptoms
TIBOLONE 2.5 mg / day
non-HT indicated for hot flushes with depression (SNRI class)
desvenlafaxine
woman on HRT with persistent irregular BLEEDING –> how to evaluate
(+) ultrasound -> (+) hysteroscopy –> biopsy –> D&C