Menopause
Symptoms and Patient Counseling
Ms. Brown is a 50 year old female with HTN, DM, Hyperlipidemia who presents stating she is having episodes of feeling hot. Upon further questioning, her peri= ods have become irregular. She otherwise has no complaints. = She specifically asks if she is going through menopause.
What is menopause?
Natural menopause is the permanent cessation of menstr= ual periods that is recognized after 12 consecutive months without menstrual periods.
What are the different stages leading to menopause?
Menopausal Transition: begins with variation in menstrual cycle length and an elevated FSH = and ends with the final menstrual period. In early transition, the cycle length is more than 7 days form the normal menstrual cycle length (21-35 days). In late transition, the cycles are= even more variable with 2 or more skipped cycles and an interval of amenorrhea f= or 60 days or more.
Perimenopause: “around the menopause” begins in menopausal transition and ends 12 months after the last menstrual period (menopause)
What are symptoms associated with menopause?
Many women go through this transition with few or no symptoms while others have significant or even disabling symptoms. We will review the more common sym= ptoms that have been attributed to ovarian aging.
Vasomotor symptoms:
Hot flashes (sudden sensation of intense heat with swe= ating and flushing typically lasting 5-10 minutes) occur more often in the late transition in to menopause and are more severe in younger women with surgic= al menopause or medical conditions or treatments that decrease the ability of ovaries to produce hormones. Hot flashes are the most common acute change during menopause. They usually resolve within 5 years but some women will continue until after age 70.
Vaginal dryness, painful intercourse (dyspareunia), atrophic vaginitis
Vaginal dryness often leads to dy= spareunia which increases in the menopause transition and can persist indefinitely.
There is limited evidence that other symptoms such as = cognitive disturbances, mood/somatic symptoms, urinary incontinence, sexual dysfuncti= on, and quality of life are associated with ovarian changes associated with menopause. Sleep disorders are often related to hot flashes. Sexual dysfunction is often relate= d to vaginal dryness. Urinary incontinence is often a result of atrophic vaginits.
When does menopause occur?
In the
What are factors associated with earlier menopause?
Lower body weight, nulliparity, smoking, never-use ocps, lower socioeconomic st= atus, race or ethnicity. Hig= her body weight is associated with later onset of menopause.
How do you diagnose menopause?
Diagnosis is based primarily on longitudinal assessmen= t of menstrual cycle history and menopausal symptoms. Measuring FSH for diagnostic purpo= ses is not recommended. Although FSH levels increase across the menopausal transition, levels can be suppressed = into the normal range after recent ovulation.&n= bsp;
How do you counsel this patient?
You explain tot her some of the physiologic changes th= at she can anticipate such as hot flashes, night sweats, vaginal dryness, etc. You can discuss with her options f= or the treatment of her symptoms which we will do at next visit in a couple of weeks. Even though other symp= toms such as mood swings and quality of life are not directly associated with ovarian failure, you should discuss that she may experience these symptoms.=
References:
National Institutes of Health State-of –the-Scie= nce Conference Statement: Managem= ent of Menopause-Related Symptoms, Ann Intern Med. 2005;142:10= 03-1013.
Clinical Manifestations and Diagno= sis of Menopause, Up to Date. October 2006