{"id":170,"date":"2020-08-13T15:58:09","date_gmt":"2020-08-13T15:58:09","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=170"},"modified":"2021-05-09T20:50:32","modified_gmt":"2021-05-09T20:50:32","slug":"47-menopause","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/overview\/47-menopause\/","title":{"rendered":"47. Menopause"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/vB6x5tDGqDE\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 5:53<\/p>\n<input type='hidden' bg_collapse_expand='69e9b569348a12052654448' value='69e9b569348a12052654448'><input type='hidden' id='bg-show-more-text-69e9b569348a12052654448' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b569348a12052654448' value='Hide Transcript'><button id='bg-showmore-action-69e9b569348a12052654448' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b569348a12052654448' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic 47 menopause this<br \/>\n00:04<br \/>\nis the story of Miss menopause<br \/>\n00:06<br \/>\nshe has just had 12 months of amenorrhea<br \/>\n00:08<br \/>\nwhich by definition makes her menopausal<br \/>\n00:10<br \/>\nshe is 51 years old which is the median<br \/>\n00:13<br \/>\nage of menopause in North America the<br \/>\n00:16<br \/>\nmenopausal transition is a natural<br \/>\n00:18<br \/>\ntransition for most women and it is<br \/>\n00:20<br \/>\nimportant to remember that women may<br \/>\n00:22<br \/>\nspend most of their lives in the<br \/>\n00:23<br \/>\npostmenopausal years the objectives of<br \/>\n00:26<br \/>\nthis video are to define menopause and<br \/>\n00:28<br \/>\ndescribe associated changes in the<br \/>\n00:30<br \/>\nhypothalamic pituitary ovarian axis<br \/>\n00:32<br \/>\ndescribe menopausal symptoms and<br \/>\n00:35<br \/>\nphysical exam findings discuss<br \/>\n00:37<br \/>\nmanagement options for patients with<br \/>\n00:39<br \/>\nperimenopausal and menopausal symptoms<br \/>\n00:41<br \/>\ncounsel patients about the menopausal<br \/>\n00:43<br \/>\ntransition and finally discuss long-term<br \/>\n00:47<br \/>\nchanges associated with menopause why do<br \/>\n00:49<br \/>\nwomen go through menopause menopause<br \/>\n00:51<br \/>\noccurs due to the program loss of<br \/>\n00:53<br \/>\nvariant follicles let&#8217;s chat for a<br \/>\n00:55<br \/>\nmoment about a woman&#8217;s germ cells or<br \/>\n00:57<br \/>\nsites remember that the number of germ<br \/>\n01:00<br \/>\ncells were low sites peak when she is 20<br \/>\n01:03<br \/>\nweeks in utero as 6 to 7 million by the<br \/>\n01:06<br \/>\ntime she is born she has 1 million at<br \/>\n01:08<br \/>\npuberty she has 400,000 at the time of<br \/>\n01:11<br \/>\nmenopause she has 2 to 300 remaining the<br \/>\n01:14<br \/>\nhypothalamus produces GnRH which<br \/>\n01:16<br \/>\nstimulates the anterior pituitary the<br \/>\n01:19<br \/>\nanterior pituitary produces FSH and LH<br \/>\n01:21<br \/>\nthis stimulates the ovary to produce<br \/>\n01:24<br \/>\nestrogen with advancing age as the<br \/>\n01:27<br \/>\nnumber of news sites decline estrogen<br \/>\n01:29<br \/>\nlevels decline the remaining sites<br \/>\n01:31<br \/>\nbecome increasingly resistant to FSH and<br \/>\n01:33<br \/>\nFSH plasma concentrations increase at<br \/>\n01:36<br \/>\nthe time of menopause FSH levels are<br \/>\n01:38<br \/>\ngreater than 30 beginning around age 40<br \/>\n01:41<br \/>\nas the number of a woman&#8217;s ovarian<br \/>\n01:43<br \/>\nfollicles decrease there are changes<br \/>\n01:44<br \/>\nthat occurred to her menstrual cycle she<br \/>\n01:47<br \/>\nmay notice shortening or lengthening of<br \/>\n01:49<br \/>\nher cycles the luteal phase of the cycle<br \/>\n01:51<br \/>\nstays the same at 13 to 14 days the<br \/>\n01:54<br \/>\nvariation at cycle length is related to<br \/>\n01:56<br \/>\nchanges in the follicular phase women<br \/>\n01:59<br \/>\nmay start noticing that their cycle<br \/>\n02:00<br \/>\nlength is now 21 days remember that the<br \/>\n02:03<br \/>\ncycle length is from the first day of<br \/>\n02:04<br \/>\none period to the first day of the next<br \/>\n02:06<br \/>\nperiod hot flashes are the most common<br \/>\n02:08<br \/>\nsymptom of the menopause transition in<br \/>\n02:11<br \/>\nu.s. women the prevalence of hot flashes<br \/>\n02:13<br \/>\nof 50 to 82 percent women described the<br \/>\n02:16<br \/>\nsudden sensation of extreme heat in the<br \/>\n02:18<br \/>\nupper body particularly the face neck<br \/>\n02:20<br \/>\nand chest<br \/>\n02:20<br \/>\nthese episodes typically last one to<br \/>\n02:22<br \/>\nfive minutes for many women the hot<br \/>\n02:25<br \/>\nflashes are tolerable and do not require<br \/>\n02:26<br \/>\nany medical therapy 33 percent of women<br \/>\n02:30<br \/>\nwho experiences hot flashes however will<br \/>\n02:32<br \/>\nexperience more than 10 hot flashes a<br \/>\n02:33<br \/>\nday for some women the hot flashes are<br \/>\n02:38<br \/>\nassociated with significant adverse<br \/>\n02:39<br \/>\noutcomes such as hampered job<br \/>\n02:41<br \/>\nproductivity and sleep deprivation some<br \/>\n02:44<br \/>\nwomen can simply use lifestyle<br \/>\n02:45<br \/>\nmodifications for their hot flashes<br \/>\n02:47<br \/>\nother women however are motivated to<br \/>\n02:49<br \/>\npursue medical therapy often based on<br \/>\n02:51<br \/>\nthe severity of their symptoms the most<br \/>\n02:53<br \/>\neffective treatment for hot flashes is<br \/>\n02:55<br \/>\nsystemic hormone therapy on average<br \/>\n02:57<br \/>\nthere&#8217;s a 75% reduction in hot flashes<br \/>\n03:00<br \/>\nboth in frequency and severity if she<br \/>\n03:02<br \/>\nhas a uterus the hormone therapy<br \/>\n03:04<br \/>\nneeds to be both estrogen and<br \/>\n03:06<br \/>\nprogesterone estrogen alone can only be<br \/>\n03:08<br \/>\nused if she does not have a uterus for<br \/>\n03:10<br \/>\nestrogen alone will increase her risk of<br \/>\n03:12<br \/>\nendometrial cancer are there risks of<br \/>\n03:14<br \/>\nhormone therapy yes the Women&#8217;s Health<br \/>\n03:17<br \/>\nInitiative was a large randomized<br \/>\n03:18<br \/>\nplacebo-controlled trial this trial<br \/>\n03:21<br \/>\ndemonstrated that there was an increased<br \/>\n03:22<br \/>\nrisk of breast cancer<br \/>\n03:24<br \/>\ncoronary heart disease stroke and Venus<br \/>\n03:26<br \/>\nfrom Baalak event in women taking<br \/>\n03:28<br \/>\nestrogen and progesterone verses<br \/>\n03:29<br \/>\npossible there were however decreased<br \/>\n03:31<br \/>\nrisk of colon cancer and fracture and<br \/>\n03:33<br \/>\nwoman taking estrogen and progesterone<br \/>\n03:35<br \/>\nfor women only receiving estrogen there<br \/>\n03:37<br \/>\nwas an increased risk of thromboembolic<br \/>\n03:39<br \/>\nevent but not an increased risk of<br \/>\n03:41<br \/>\ncardiovascular event or breast cancer<br \/>\n03:43<br \/>\nit&#8217;s important to note that it&#8217;s<br \/>\n03:45<br \/>\ndifficult to generalize the findings<br \/>\n03:47<br \/>\nfrom the WHI on younger more recently<br \/>\n03:49<br \/>\nmenopausal women since the WHI examined<br \/>\n03:51<br \/>\nwomen aged 50 to 77 years old and many<br \/>\n03:54<br \/>\nwere past the menopausal transition at<br \/>\n03:56<br \/>\nthe time of the study what other options<br \/>\n03:58<br \/>\nare available for treatment of hot<br \/>\n03:59<br \/>\nflashes SSRIs and SNRIs are effective<br \/>\n04:03<br \/>\ntreatments and they reduce hot flashes<br \/>\n04:05<br \/>\naround 50 to 62%<br \/>\n04:06<br \/>\nherbal therapies such as black cohosh or<br \/>\n04:09<br \/>\nphytoestrogens have not been shown to be<br \/>\n04:11<br \/>\nsuperior to placebo bioidentical<br \/>\n04:14<br \/>\nhormones are not recommended over<br \/>\n04:16<br \/>\nconventional hormone therapy for there<br \/>\n04:17<br \/>\nis limited evidence<br \/>\n04:19<br \/>\ntheir safety purity potency and efficacy<br \/>\n04:21<br \/>\ndeclining estrogen levels can induce a<br \/>\n04:23<br \/>\nchange in women&#8217;s sleep cycles<br \/>\n04:25<br \/>\nindependent of hot flashes and sleep<br \/>\n04:27<br \/>\ndisturbances are one of the most common<br \/>\n04:29<br \/>\nand disabling effects of menopause bone<br \/>\n04:31<br \/>\ndensity decreases in men and women with<br \/>\n04:33<br \/>\naging however the rate of bone loss<br \/>\n04:35<br \/>\nincreases with menopause bone density<br \/>\n04:37<br \/>\ndiminishes at a rate of one to two<br \/>\n04:39<br \/>\npercent per year in postmenopausal women<br \/>\n04:41<br \/>\ncompared with 0.5 percent per year in<br \/>\n04:44<br \/>\nperimenopausal women the vaginal<br \/>\n04:46<br \/>\nepithelium and euro epithelium are also<br \/>\n04:48<br \/>\nall estrogen dependent tissues pelvic<br \/>\n04:51<br \/>\norgan prolapse and a trophic urethritis<br \/>\n04:53<br \/>\ncan result when the pair of vaginal<br \/>\n04:56<br \/>\ntissues that support the bladder and<br \/>\n04:57<br \/>\nrectum become a trophic up to 40 percent<br \/>\n05:00<br \/>\nof menopausal women will experience one<br \/>\n05:01<br \/>\nor more symptoms of vaginal atrophy<br \/>\n05:04<br \/>\nvaginal atrophy may present with itching<br \/>\n05:06<br \/>\nand burning and the loss of vaginal<br \/>\n05:08<br \/>\nrugae and the loss of elasticity can<br \/>\n05:10<br \/>\ncause a narrowing and shortening of the<br \/>\n05:12<br \/>\nvagina vaginal atrophy and vaginal<br \/>\n05:15<br \/>\ndryness can also become symptomatic<br \/>\n05:16<br \/>\nduring intercourse and can cause<br \/>\n05:18<br \/>\nsignificant dyspareunia vaginal<br \/>\n05:20<br \/>\nlubrication x&#8217;<br \/>\n05:21<br \/>\nvaginal moisturizers and vaginal<br \/>\n05:22<br \/>\nestrogens can all provide symptom relief<br \/>\n05:24<br \/>\nthis concludes the aapko educational<br \/>\n05:27<br \/>\nvideo on menopause<br \/>\n05:28<br \/>\nin summary menopause is a natural<br \/>\n05:30<br \/>\ntransition for most women we have<br \/>\n05:32<br \/>\ndiscussed the hormonal changes that<br \/>\n05:33<br \/>\noccur with menopause discuss symptoms<br \/>\n05:35<br \/>\nand physical exam findings and<br \/>\n05:37<br \/>\nmanagement options that are available if<br \/>\n05:39<br \/>\na woman needs it<\/p>\n<p><\/div>\n<hr \/>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 5:53<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":46,"menu_order":47,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-170","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/170","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=170"}],"version-history":[{"count":1,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/170\/revisions"}],"predecessor-version":[{"id":2852,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/170\/revisions\/2852"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=170"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}