Menopause

Definition
Menopause: 1 year after cessation of
menstruation
FMP: 51.5 years
Perimenopause or climacteric or menopausal
transition
in the late reproductive years: 40s to early 50s
Irregular menstrual cycle 1 year after
permanent cessation of menses
4 to 7 years, onset is 47 years
Stages of Reproductive Age
*Schorge JO, Schaffer JI, Halvorson LM, Hoffman BL, Bradshaw KD, Cunningham FG. Williams gynecology. New York: McGraw-Hills. 2008.
Physiological Changes
HPO Axis
FSH rise slightly increased ovarian follicular response
increase in serum estrogen levels increased number of
follicles in the stimulated cohort
An accelerated rate of ovarian follicles loss until late
menopausal transition (supply is depleted)
Reduced quality and capability of aging follicles to secrete
inhibin
Ovarian failure in the menopause + ovarian steroid
hormone release ceases the negative-feedback loop is
opened GnRH is released at maximal frequency and
amplitude circulating FSH and LH levels rise up to
fourfold higher than in the reproductive years
Symptoms
Changes in menstrual patterns
Vasomotor symptoms
Psychological and metal disturbances
Sexual dysfunction
Somatic symptoms
Other symptoms
*Schorge JO, Schaffer JI, Halvorson LM, Hoffman BL, Bradshaw KD, Cunningham FG. Williams gynecology. New York: McGraw-Hills. 2008.
*Schorge JO, Schaffer JI, Halvorson LM, Hoffman BL, Bradshaw KD, Cunningham FG. Williams gynecology. New York: McGraw-Hills. 2008.
*Schorge JO, Schaffer JI, Halvorson LM, Hoffman BL, Bradshaw KD, Cunningham FG. Williams gynecology. New York: McGraw-Hills. 2008.
Disorder in Menopause Schedule
Premature Menopause
Before 40 years
Hereditary, severe nutritional disorder, chronic
disease, diseases that effected both of ovarian
No need therapy

Delayed Menopause
After 52 years explore
Constitutional, uterine fibromyoma, ovarian tumor,
endometrial cancer
Management
Psychotherapy
Sedative
Diet management
Hormonal substitution estrogen
Estrogen Therapy
Perimenopause: responsive uterine
purpose: biphasic menstruation period as in normal
estrogen day 5-25 & progesterone day 26-30
stop if normal menstruation or diminished
symptoms
Menopause & post-menopause: unresponsive
uterine
Purpose: control symptoms
Weak estrogen (estriol) 21 consecutive days, none in 7
days
stop if diminished symptoms