|
Menopause can be defined as
the spontaneous cessation of menses. In the United States, the average age at
menopause is 51 years old. While all women have reached menopause by the sixth
decade, menopause before age 30 is considered premature and further medical
investigation is warranted.
| Typical signs and symptoms
that accompany menopause include hot flashes, insomnia, depression, anxiety, and
atrophy of the skin and urogenital tract. Migraines, breast tenderness,
arteriosclerosis, and osteoporosis are also more common ensuing menopause. |
The etiology
of menopause
is usually physiologic and results from a paucity of viable oocytes. Surgical
causes of menopause occur when functional ovaries are resected due to disease or
as part of a hysterectomy. Medical interventions for the treatment of
endometriosis with danazol can also lead to menopause, albeit temporary.
|
Pathological findings
are
generally related to the presenting signs and symptoms and include an atrophic
uterus on physical examination, loss of ruggae (folds) in the vaginal wall, and
shortened stature due to osteoporosis.
| Follow-up for the
uncomplicated patient will consist of an annual Pap smears, bimanual
examinations, mammography, and bone density determination. |
Current therapy consists of
oral estrogens, either conjugated premarin or estradiol. Calcium, vitamin D,
bisphosphonates, and a progestin if the uterus is still intact are used as
adjuncts.
Common regimens include
Premarin at 0.625 mg and Provera 2.5 mg every day or Premarin 0.625 mg for 25
days per month plus Provera 5 mg during days 21 – 25.
| Contraindications
to estrogen therapy include estrogen dependent malignancies, unexplained abnormal
vaginal bleeding, history of thrombophlebitis, active hepatic disease, or
malignant melanoma. |
  
|
