Menopause resident survival guide
|Menopause Resident Survival Guide Microchapters|
Synonyms and keywords: Perimenopause approach, Climacteric workup, Approach to menopause, Menopause workup, Menopause management
Menopause is a clinical state indicating the permanent cessation of ovarian function. Perimenopause refers to the period of transitioning before menopause characterised by irregular menstrual cycles. The diagnosis of menopause is made retrospectively based on the absence of menstrual cycles for 12 months. The average age of menopause is 51 years. Women can have symptoms of hot flashes, night sweats, sleep disturbance, mood changes, decreased libido, vaginal dryness, dyspareunia, etc. Women with intolerable symptoms can be treated with hormonal and non hormonal therapy. Conditions where menopause can occur early are primary ovarian insufficiency, bilateral oophorectomy, chemotherapy and radiation induced.
- Natural menopause
- Premature ovarian failure or Early menopause
- Surgical menopause
- Chemotherapy and radiation induced menopause
|Presence of Menopausal Symptoms|
+ irregular/absent menstrual periods
|≥45 years||40-45 years||≤40 years|
|Uterus||Rule out other causes|
|Rule out |
medical and surgical causes of
FSH and Estradiol
4-6 weeks apart
|Menopause diagnosed |
|Irregular periods+ |
|Amenorrhea>12 months |
± menopausal symptoms
|Amenorrhea > 12 months||Menopause ruled out||FSH elevated |
|Perimenopause||Menopause||Early menopause||Premature ovarian failure|
syndrome of menopause
(vaginal dryness, itching,
dyspareunia, urinary incontinence)
|Vasomotor symptoms |
(hot flashes, night sweats)
|Water based lubricants |
|Based on patient preference||Regular exercise |
Avoid alcohol and caffeine
|-Avoid smoking, caffeine, alcohol|
-Use of fan, cool bedroom, cool shower
|Post hysterectomy status||When hormonal use|
(History of breast cancer,
Undiagnosed vaginal bleeding, etc.
|Hysterectomised||Uterus in-situ||Paroxetine(SSRI) |
- In women with moderate risk of cardiovascular disease requiring treatment for vasomotor symptoms of menopause, use transdermal estradiol alone or in combination with micronised progesterone in women with uterus instead of oral oestrogen preparations. 
- In women on hormone replacement therapy, use the lowest possible dose for the shortest duration(3-5 years).
- In women on hormone replacement therapy with unscheduled bleeding, evaluate for endometrial hyperplasia and endometrial cancer.
- In women with primary ovarian insufficiency and surgical menopause, hormonal replacement therapy to be given until anticipated age of menopause.
- Counsel patients regarding continued symptoms after discontinuing hormone replacement therapy.
- To maintain bone health recommended weight-bearing exercises, calcium and vitamin D supplements.
- Do not use measurements of anti müllerian hormone, inhibin B, estradiol, FSH, LH, testosterone in the diagnosis of menopause in women of age ≥45 years.  
- Do not use FSH levels in diagnosing menopause in women <45 years of age who are on oral contraceptives.
- Do not use hormonal replacement therapy in women with high risk for cardiovascular disease, venous thromboembolism, breast cancer.
- Do not recommend use of complimentary medicine treatment options like black cohash, omega-3 fatty acids, red clover, vitamin E due to lack of sufficient data proving its efficacy.
- Do not use ospemifene for vaginal dryness in women with history of breast cancer.
- Rodriguez M, Shoupe D (2015). "Surgical Menopause". Endocrinol Metab Clin North Am. 44 (3): 531–42. doi:10.1016/j.ecl.2015.05.003. PMID 26316241.
- Secoșan C, Balint O, Pirtea L, Grigoraș D, Bălulescu L, Ilina R (2019). "Surgically Induced Menopause-A Practical Review of Literature". Medicina (Kaunas). 55 (8). doi:10.3390/medicina55080482. PMC 6722518 Check
|pmc=value (help). PMID 31416275.
- Torrealday S, Kodaman P, Pal L (2017). "Premature Ovarian Insufficiency - an update on recent advances in understanding and management". F1000Res. 6: 2069. doi:10.12688/f1000research.11948.1. PMC 5710309. PMID 29225794.
- Liem GS, Mo FK, Pang E, Suen JJ, Tang NL, Lee KM; et al. (2015). "Chemotherapy-Related Amenorrhea and Menopause in Young Chinese Breast Cancer Patients: Analysis on Incidence, Risk Factors and Serum Hormone Profiles". PLoS One. 10 (10): e0140842. doi:10.1371/journal.pone.0140842. PMC 4613138. PMID 26485568.
- Stuenkel, Cynthia A.; Davis, Susan R.; Gompel, Anne; Lumsden, Mary Ann; Murad, M. Hassan; Pinkerton, JoAnn V.; Santen, Richard J. (2015). "Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology & Metabolism. 100 (11): 3975–4011. doi:10.1210/jc.2015-2236. ISSN 0021-972X.
- "ACOG Releases Clinical Guidelines on Management of Menopausal Symptoms - Practice Guidelines - American Family Physician".
- "What are the treatments for other symptoms of menopause? | NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development".