Menopause

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Contents

Introduction

Etiology

Epidemiology

  • average age of menopause is 51 years
  • range is 40-60 years
  • smokers may have accelerated menopause
  • 75-80% of women experience discomfort associated with menopause
  • 10-15% experience symptoms that interfere with activities of daily living
  • 25% complain of symptoms lasting more than 5 years

Pathology

Clinical-manifestations

  • * the 2 manifestations that may be definitively attributed to menopause

Laboratory

  • in general, diagnosis is clinical & no specific laboratory testing is required
  • serum gonadotropins
  • check hormone levels on 7th day of pill-free interval
  • serum estradiol < 25 pg/mL & FSH/LH ratio of > 1 indicates menopause

Diagnostic-procedures

Complications

Management

  • oral agents
  • indications:
  • continuous therapy
  • diet

More General Terms

Additional Terms

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 451-53
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, American College of Physicians, Philadelphia 1998, 2006, 2009
  3. Prescriber's Letter 7(8):44 2000
  4. Journal Watch 20(10):80, 2000 Crawford et al Menopause 7:96, 2000
  5. Greendale et al Lancet 353:571, 1999
  6. Solomon DH, in: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  7. Journal Watch 23(3):28, 2003 Barnabei VM et al, Obstet Gynecol 100:1209, 2002
  8. Prescriber's Letter 11(6):36 2004 Detail-Document#: [1] (subscription needed) [2]
  9. Journal Watch 24(16):130, 2004 Kreijkamp-Kaspers S, Kok L, Grobbee DE, de Haan EH, Aleman A, Lampe JW, van der Schouw YT. Effect of soy protein containing isoflavones on cognitive function, bone mineral density, and plasma lipids in postmenopausal women: a randomized controlled trial. JAMA. 2004 Jul 7;292(1):65-74. PMID: [3]
  10. NIH News NIH State-of-the-Science Panel Calls for 'Demedicalization' of Menopause [4]
  11. Journal Watch 25(17):134, 2005 Ockene JK, Barad DH, Cochrane BB, Larson JC, Gass M, Wassertheil-Smoller S, Manson JE, Barnabei VM, Lane DS, Brzyski RG, Rosal MC, Wylie-Rosett J, Hays J. Symptom experience after discontinuing use of estrogen plus progestin. JAMA. 2005 Jul 13;294(2):183-93. PMID: [5]
    - Petitti DB. Some surprises, some answers, and more questions about hormone therapy: further findings from the Women's Health Initiative. JAMA. 2005 Jul 13;294(2):245-6. No abstract available. PMID: [6]
  12. The role of testosterone therapy in postmenopausal women: position statement of The North American Menopause Society [7] corresponding NGC guideline withdrawn 12/10
  13. Cohen LS et al, Risk for new onset of depression during the menopausal transition: The Harvard study of moods and cycles. Arch Gen Psychiatry 2006; 63:385 PMID: [8]
    - Freeman EW et al, Associations of hormones and menopausal status with depressed mood in women with no history of depression Gen Psychiatry 2006; 63:375 PMID: [9]
  14. Kok HS et al, Heart disease risk determines menopausal age rather than the reverse. J Am Coll Cardiol 2006; 47:1976 PMID: [10]
    - Bittner V Menopause and cardiovascular risk. Cause of consequence? J Am Coll Cardiol 2006; 47:1984 PMID: [11]
  15. Henderson VW. The neurology of menopause. Neurologist. 2006 May;12(3):149-59. Review. PMID: [12]
  16. Col NF et al Duration of vasomotor symptoms in middle-aged women: A longitudinal study. Menopause 2009 May/Jun; 16:453 PMID: [13]
  17. Avis NE et al Longitudinal changes in sexual functioning as women transition through menopause: Results from the Study of Women's Health Across the Nation. Menopause 2009 May/Jun; 16:442. PMID: [14]
  18. Freeman EW et al Efficacy of Escitalopram for Hot Flashes in Healthy Menopausal Women: A Randomized Controlled Trial JAMA. 2011;305(3):267-274 <PubMed> PMID: [15] <Internet> [16]
  19. Bromberger JT et al. Major depression during and after the menopausal transition: Study of Women's Health Across the Nation (SWAN). Psychol Med 2011 Feb 9 <PubMed> PMID: [17] <Internet> [18]
  20. Levis S et al. Soy isoflavones in the prevention of menopausal bone loss and menopausal symptoms: A randomized, double-blind trial. Arch Intern Med 2011 Aug 8/22; 171:1363 PMID: [19]
  21. North American Menopause Society [20]
  22. Menopause and Bladder Control (Patient Information) [21]
    - NIH Institute and Center Resources [22]
  23. National Guideline Clearinghouse
    - Recommendations for estrogen and progestogen use in peri- and postmenopausal women: October 2004 position statement of The North American Menopause Society.
    - Bone health. In: Menopause and osteoporosis update 2009. Society of Obstetricians and Gynaecologists of Canada ngc-guideline: [23]
    - Cardiovascular disease. In: Menopause and osteoporosis update 2009. Society of Obstetricians and Gynaecologists of Canada ngc-guideline: [24]
    - Hormone therapy and breast cancer. In: Menopause and osteoporosis update 2009. Society of Obstetricians and Gynaecologists of Canada ngc-guideline: [25]
    - Mood, memory, and cognition. In: Menopause and osteoporosis update 2009. Society of Obstetricians and Gynaecologists of Canada ngc-guideline: [26]
    - Urogenital health. In: Menopause and osteoporosis update 2009. Society of Obstetricians and Gynaecologists of Canada ngc-guideline: [27]
    - Vasomotor symptoms. In: Menopause and osteoporosis update 2009. Society of Obstetricians and Gynaecologists of Canada ngc-guideline: [28]

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