Menopause is the cessation of menses above the age of 40. It is diagnosed retroactively based on lack of menses for 12 or more months. It is treated with hormone therapy.
Pathophysiology
- Loss of ovarian follicular function
- Decreased progesterone production
- Increase in LH and FSH
- Permanent cessation of menses
Stages
- Reproductive stage
- Perimenopause
- Menopausal transition
- Postmenopause
Contextual Factors
- Female > age 40
Clinical Manifestation
- Breast tenderness
- Moodiness
- Hot flashes
GU
- Exacerbation of menstrual migraines
- Changes in menstrual flow
- Vulvovaginal atrophy
- Urinary urgency
- Dysuria
- Frequent urinary tract infections and/or vaginitis
Musculoskeleteal
- Bone density loss
Complications
- Normal part of life, IDK
Diagnosis
- Menstrual history: no menses for 12 months with no other suspected cause
- FSH level - only needed for patients with hysterectomy or premature menopause
Age Timing
| Classification | Age |
|---|---|
| Premature menopause | < 40 |
| Early menopause | 40 - 45 |
| Menopause | > 45 |
Treatment
- Hormone therapy: estrogen, progestogen, selective estrogen receptor modulator
- Non-hormonal medications: SSRI, neurokinin receptor antagonist
Criteria for Osteoporosis Screening
- High risk of fracture
- History of eating disorder, low BMI, chronic corticosteroid use, gastric bypass surgery, Crohn disease, malabsorption syndrome, or prior fragility fracture
- Age 65 or older