Menopause resident survival guide

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Menopause Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
Treatment
Do's
Don'ts

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayeesha Kattubadi, M.B.B.S[2]

Synonyms and Keywords: Perimenopause approach, Climacteric workup, Approach to menopause, Menopause workup, Menopause management

Overview

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.

Causes

Common Causes

Commn causes of menopause include: [1] [2] [3] [4]

Diagnosis

Shown below is an algorithm summarizing the diagnosis of menopause. [5][6][7]

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Presence of Menopausal Symptoms
+ irregular/absent menstrual periods
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Age
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
≥45 years
 
 
 
 
 
 
 
 
 
 
40-45 years
 
 
 
 
 
 
 
 
 
≤40 years
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Uterus
 
 
 
 
 
 
 
 
 
 
Rule out other causes
like
pregnancy,
hyperthyroidism,
prolactinoma
 
 
 
 
 
 
 
 
 
Rule out
medical and surgical causes of
amenorrhea/oligomenorrhe
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Absent
 
 
 
Present
 
 
 
 
Normal
 
 
 
Abnormal
 
 
 
 
 
 
Measure
FSH and Estradiol
two samples
4-6 weeks apart
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Menopause diagnosed
based on
symptoms
 
Irregular periods+
menopausal symptoms
 
Amenorrhea>12 months
± menopausal symptoms
 
 
Amenorrhea > 12 months
 
 
 
Menopause ruled out
 
 
 
 
 
 
FSH elevated
Estradiol depressed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Perimenopause
 
Menopause
 
 
Early menopause
 
 
 
 
 
 
 
 
 
 
 
 
Premature ovarian failure
 
 
 
 
 
 
 

Treatment

Shown below is an algorithm summarizing the treatment of menopause. [5] [8] [9]

 
 
 
 
 
 
 
 
 
 
 
 
 
Menopausal symptoms
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Genitourinary
syndrome of menopause
(vaginal dryness, itching,
dyspareunia, urinary incontinence)
 
 
 
 
 
 
 
 
 
Vasomotor symptoms
(hot flashes, night sweats)
 
 
 
 
 
 
 
 
Sleep problems
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Water based lubricants
Ospemifene
Vaginal oestrogen
 
 
 
 
 
 
 
 
 
Based on patient preference
 
 
 
 
 
 
 
 
Regular exercise
Sleep hygiene
Avoid alcohol and caffeine
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Life style
modification
 
 
 
 
 
 
 
Medical therapy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
-Avoid smoking, caffeine, alcohol
-Use of fan, cool bedroom, cool shower
-Relaxation exercises
 
 
 
Hormonal replacement
therapy
 
 
 
 
 
Non-hormonal
therapy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Post hysterectomy status
 
 
 
 
 
When hormonal use
is contraindicated
(History of breast cancer,
Venous thromboembolism,
Undiagnosed vaginal bleeding, etc.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hysterectomised
 
 
 
Uterus in-situ
 
 
Paroxetine(SSRI)
Clonidine
Gabapentin
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Oestrogen alone
 
 
 
Oestrogen+Progesterone
 
 
 
 
 
 
 
 

Do's

[10]

Don'ts

References

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 5.0 5.1 5.2 5.3 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.
  6. https://www.nice.org.uk/guidance/ng23/chapter/Recommendations
  7. https://www.menopause.org.au/hp/gp-hp-resources/300-diagnosing-menopause
  8. "ACOG Releases Clinical Guidelines on Management of Menopausal Symptoms - Practice Guidelines - American Family Physician".
  9. "What are the treatments for other symptoms of menopause? | NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development".
  10. https://www.nichd.nih.gov/health/topics/menopause/conditioninfo/treatments
  11. https://www.nice.org.uk/guidance/ng23/chapter/Recommendations