Perimenopause

Define Perimenopause

2-4 year span that begins immediately before and ends immediately after, menopause

Premature Ovarian Failure

Before age 40, if before 30 than suspect weird Karyotype or Autoimmune disease

Know the risks of continuous E&P therapy

Cardiovascular disease and cancer

Define Menopause

Cessation of menses due to Ovarian follicular atresia, occuring after age of 40 (mean is 51) Follicles are what secretes the hormones that regulate menses LH and FSH will be elevated (good Dx tool)

Know that estrogen replacement therapy is usually effective in treating the hot flushes

Clonidine can be used if E contraindicated SERMS are good for bone health, but not Hot Flushes

Treatment of Hypo-Estrogen

E&P therapy, as to avoid endometrial cancer risk (if woman still has uterus)

How do we measure Estrogen replacement success? (FSH vs LH)

FSH only responds to Inhibin, so it will still be high LH has to be measured

Primary symptoms of Hypo-Estrogen

Hot Flushes Vaginal Dryness and Atrophy

understand that elevated serum FSH and LH levels help to confirm the diagnosis

However, FHS can NOT be used to measure Estrogen therapy success, as it only answers to inhibin and will still be high

Understand the normal presentation of women in the perimenopausal state ... when do women start to feel these symptoms ?

Perimenopausal / Climacteric State -Irregular menses -Feelings of inadequacy -Warmth and sweating sensations (Hot Flushes) Between 40-51 years old, hypo-Estrogen primarily hot flushes .. .majority of women will feel

Most common site of Osteoporosis Associated fracture?

Thoracic spine compression fracture

Woman who can't or wont take Estrogen for hot flushes?

Use Clonidine. SERMS can prevent bone loss, they don't help Hot Flushes

Current indication for hormone replacement in menopausal woman?

Vasomotor symptoms (Hot Flushes) ... Lowest doses/shortest durations feasible should be used

Bone mass maintenance post menopause

Weight baring, Vit D, Ca2+ and Estrogen replacement