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APGO educational topic 47 menopause this
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is the story of Miss menopause
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she has just had 12 months of amenorrhea
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which by definition makes her menopausal
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she is 51 years old which is the median
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age of menopause in North America the
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menopausal transition is a natural
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transition for most women and it is
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important to remember that women may
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spend most of their lives in the
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postmenopausal years the objectives of
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this video are to define menopause and
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describe associated changes in the
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hypothalamic pituitary ovarian axis
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describe menopausal symptoms and
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physical exam findings discuss
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management options for patients with
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perimenopausal and menopausal symptoms
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counsel patients about the menopausal
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transition and finally discuss long-term
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changes associated with menopause why do
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women go through menopause menopause
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occurs due to the program loss of
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variant follicles let’s chat for a
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moment about a woman’s germ cells or
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sites remember that the number of germ
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cells were low sites peak when she is 20
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weeks in utero as 6 to 7 million by the
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time she is born she has 1 million at
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puberty she has 400,000 at the time of
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menopause she has 2 to 300 remaining the
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hypothalamus produces GnRH which
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stimulates the anterior pituitary the
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anterior pituitary produces FSH and LH
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this stimulates the ovary to produce
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estrogen with advancing age as the
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number of news sites decline estrogen
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levels decline the remaining sites
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become increasingly resistant to FSH and
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FSH plasma concentrations increase at
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the time of menopause FSH levels are
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greater than 30 beginning around age 40
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as the number of a woman’s ovarian
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follicles decrease there are changes
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that occurred to her menstrual cycle she
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may notice shortening or lengthening of
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her cycles the luteal phase of the cycle
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stays the same at 13 to 14 days the
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variation at cycle length is related to
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changes in the follicular phase women
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may start noticing that their cycle
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length is now 21 days remember that the
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cycle length is from the first day of
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one period to the first day of the next
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period hot flashes are the most common
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symptom of the menopause transition in
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u.s. women the prevalence of hot flashes
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of 50 to 82 percent women described the
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sudden sensation of extreme heat in the
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upper body particularly the face neck
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and chest
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these episodes typically last one to
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five minutes for many women the hot
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flashes are tolerable and do not require
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any medical therapy 33 percent of women
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who experiences hot flashes however will
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experience more than 10 hot flashes a
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day for some women the hot flashes are
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associated with significant adverse
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outcomes such as hampered job
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productivity and sleep deprivation some
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women can simply use lifestyle
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modifications for their hot flashes
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other women however are motivated to
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pursue medical therapy often based on
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the severity of their symptoms the most
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effective treatment for hot flashes is
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systemic hormone therapy on average
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there’s a 75% reduction in hot flashes
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both in frequency and severity if she
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has a uterus the hormone therapy
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needs to be both estrogen and
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progesterone estrogen alone can only be
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used if she does not have a uterus for
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estrogen alone will increase her risk of
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endometrial cancer are there risks of
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hormone therapy yes the Women’s Health
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Initiative was a large randomized
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placebo-controlled trial this trial
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demonstrated that there was an increased
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risk of breast cancer
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coronary heart disease stroke and Venus
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from Baalak event in women taking
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estrogen and progesterone verses
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possible there were however decreased
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risk of colon cancer and fracture and
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woman taking estrogen and progesterone
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for women only receiving estrogen there
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was an increased risk of thromboembolic
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event but not an increased risk of
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cardiovascular event or breast cancer
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it’s important to note that it’s
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difficult to generalize the findings
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from the WHI on younger more recently
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menopausal women since the WHI examined
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women aged 50 to 77 years old and many
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were past the menopausal transition at
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the time of the study what other options
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are available for treatment of hot
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flashes SSRIs and SNRIs are effective
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treatments and they reduce hot flashes
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around 50 to 62%
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herbal therapies such as black cohosh or
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phytoestrogens have not been shown to be
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superior to placebo bioidentical
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hormones are not recommended over
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conventional hormone therapy for there
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is limited evidence
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their safety purity potency and efficacy
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declining estrogen levels can induce a
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change in women’s sleep cycles
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independent of hot flashes and sleep
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disturbances are one of the most common
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and disabling effects of menopause bone
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density decreases in men and women with
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aging however the rate of bone loss
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increases with menopause bone density
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diminishes at a rate of one to two
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percent per year in postmenopausal women
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compared with 0.5 percent per year in
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perimenopausal women the vaginal
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epithelium and euro epithelium are also
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all estrogen dependent tissues pelvic
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organ prolapse and a trophic urethritis
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can result when the pair of vaginal
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tissues that support the bladder and
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rectum become a trophic up to 40 percent
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of menopausal women will experience one
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or more symptoms of vaginal atrophy
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vaginal atrophy may present with itching
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and burning and the loss of vaginal
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rugae and the loss of elasticity can
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cause a narrowing and shortening of the
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vagina vaginal atrophy and vaginal
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dryness can also become symptomatic
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during intercourse and can cause
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significant dyspareunia vaginal
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lubrication x’
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vaginal moisturizers and vaginal
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estrogens can all provide symptom relief
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this concludes the aapko educational
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video on menopause
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in summary menopause is a natural
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transition for most women we have
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discussed the hormonal changes that
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occur with menopause discuss symptoms
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and physical exam findings and
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management options that are available if
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a woman needs it