CLINICAL CLARIFICATION12, 22, 1, 5
• Peri-menopause, also known as the menopausal transition, precedes the menopause and is characterized by irregular menstrual cycles with associated endocrinologic changes and symptoms of hypoestrogenism.
• Menopause is defined as amenorrhea for 12 months due to gametogenic failure, thus marking the beginning of the post-menopause. CLASSIFICATION20
• Peri-menopause
○ Early
– Variable cycle length, > 7 days different from normal
– Increased intermenstrual interval
○ Late
– >/= 2 missed menstrual cycles
– >/= 60 days of amenorrhea
• Menopause
○ Early
– < 4 years after the menopause
○ Late
– >/= 4 years after the menopause until death
DIAGNOSIS
CLINICAL PRESENTATION9, 4, 14, 15, 13, 21
• History 9, 22, 17, 13 …show more content…
Postmenopausal women should be re-evaluated periodically as clinically appropriate to determine if treatment is still necessary.
– Estrogen gel
□ Estradiol Topical gel; Adult females (40+ years): Apply entire contents of a 0.25 g/day unit dose pack to a 5 X 7 inch area on the upper thigh once daily. Adjust dose as clinically indicated.
□ Estradiol Topical gel; Adult females (40+ years): Initially, apply 1 pump actuation (0.87 g estradiol gel delivers 12.5 mcg/day) once daily to the upper arm. Adjust dose as clinically indicated.
□ Estradiol Topical gel; Adult females (40+ years): Apply 1 actuation of the pump (1.25 g estradiol gel-0.75 mg of estradiol) to 1 arm once daily.
– Estrogen spray
□ Estradiol Topical solution, spray; Adult females (40+ years): Initially, apply 1 spray (pump actuation; delivers 1.53 mg estradiol) to the forearm qAM; if needed, adjust dose up to 2—3 sprays qAM.
– Estrogen vaginal ring
□ Estradiol Acetate Vaginal insert; Adult females (40+ years): Insert 1 vaginal ring (delivering 50 or 100 mcg/24 hours) into upper 1/3 of vaginal vault. Initiate with lowest dose. Keep in place continuously for 3 months, then …show more content…
• Screening tests
○ No screening tests are indicated for the peri- or post-menopause.
PREVENTION
• There are no preventive measures for the peri- or post-menopause.
Peri-menopause and menopause
SYNOPSIS
KEY POINTS
• The most common complaints of the peri-menopause and menopause include menstrual cycle irregularity and vasomotor symptoms. • The diagnosis of peri-menopause and menopause are based on history of menstrual cycles, symptoms of hypoestrogenism, and may be supported with laboratory findings.
• The peri- and post-menopause have no associated co-morbidities.
• Treatment of the peri-menopause should focus on alleviating symptoms associated with gametogenic failure.
• The complications which are associated with the menopause include bone loss and cardiovascular disease.
• Treatment of symptoms secondary to hypoestrogenism has no prognostic significance. Rather, preventive care and treatment of aging-associated medical conditions will optimize the quality of life in post-menopausal women.
URGENT ACTION
• No urgent actions are indicated for the peri- or post-menopause.
PITFALLS
• Peri-menopausal women in their 40s who are sexually active and have undesired fertility require a reliable form of
• Peri-menopause, also known as the menopausal transition, precedes the menopause and is characterized by irregular menstrual cycles with associated endocrinologic changes and symptoms of hypoestrogenism.
• Menopause is defined as amenorrhea for 12 months due to gametogenic failure, thus marking the beginning of the post-menopause. CLASSIFICATION20
• Peri-menopause
○ Early
– Variable cycle length, > 7 days different from normal
– Increased intermenstrual interval
○ Late
– >/= 2 missed menstrual cycles
– >/= 60 days of amenorrhea
• Menopause
○ Early
– < 4 years after the menopause
○ Late
– >/= 4 years after the menopause until death
DIAGNOSIS
CLINICAL PRESENTATION9, 4, 14, 15, 13, 21
• History 9, 22, 17, 13 …show more content…
Postmenopausal women should be re-evaluated periodically as clinically appropriate to determine if treatment is still necessary.
– Estrogen gel
□ Estradiol Topical gel; Adult females (40+ years): Apply entire contents of a 0.25 g/day unit dose pack to a 5 X 7 inch area on the upper thigh once daily. Adjust dose as clinically indicated.
□ Estradiol Topical gel; Adult females (40+ years): Initially, apply 1 pump actuation (0.87 g estradiol gel delivers 12.5 mcg/day) once daily to the upper arm. Adjust dose as clinically indicated.
□ Estradiol Topical gel; Adult females (40+ years): Apply 1 actuation of the pump (1.25 g estradiol gel-0.75 mg of estradiol) to 1 arm once daily.
– Estrogen spray
□ Estradiol Topical solution, spray; Adult females (40+ years): Initially, apply 1 spray (pump actuation; delivers 1.53 mg estradiol) to the forearm qAM; if needed, adjust dose up to 2—3 sprays qAM.
– Estrogen vaginal ring
□ Estradiol Acetate Vaginal insert; Adult females (40+ years): Insert 1 vaginal ring (delivering 50 or 100 mcg/24 hours) into upper 1/3 of vaginal vault. Initiate with lowest dose. Keep in place continuously for 3 months, then …show more content…
• Screening tests
○ No screening tests are indicated for the peri- or post-menopause.
PREVENTION
• There are no preventive measures for the peri- or post-menopause.
Peri-menopause and menopause
SYNOPSIS
KEY POINTS
• The most common complaints of the peri-menopause and menopause include menstrual cycle irregularity and vasomotor symptoms. • The diagnosis of peri-menopause and menopause are based on history of menstrual cycles, symptoms of hypoestrogenism, and may be supported with laboratory findings.
• The peri- and post-menopause have no associated co-morbidities.
• Treatment of the peri-menopause should focus on alleviating symptoms associated with gametogenic failure.
• The complications which are associated with the menopause include bone loss and cardiovascular disease.
• Treatment of symptoms secondary to hypoestrogenism has no prognostic significance. Rather, preventive care and treatment of aging-associated medical conditions will optimize the quality of life in post-menopausal women.
URGENT ACTION
• No urgent actions are indicated for the peri- or post-menopause.
PITFALLS
• Peri-menopausal women in their 40s who are sexually active and have undesired fertility require a reliable form of