Menopause - Diagnosis and Management Summary:
Definition: ...
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Menopause - Diagnosis and Management Summary:

Definition: Amenorrhea x12 mo w/o alt etiology (no need to check labs), avg onset age 51, suspect 1° ovarian insuff if <40 yo

Vasomotor sx (hot flashes): 

 • Systemic hormone tx (estrogen + progestin, estrogen monotx if hysterectomy): most effective therapy but only recommended if <60 yo and for <5 yrs duration; 

 • start at 0.5 mg/day; side effects include breast tenderness, vaginal bleeding; ↓CRC, fracture risk; ↑breast CA, CVD, VTE; Ø inc risk of mortality after 5-7 yrs; 

 • Alternatives: SSRIs (paroxetine), SNRIs (venlafaxine), gabapentin, clonidine

Vaginal sx (dryness, burning, pain w/ intercourse):

 • Lubricants (KY): prior to intercourse; Moisturizers (Replens): longer-term relief

 • Topical estrogen therapy: ring, tablet, cream; start at 0.3 mg/day; Ø inc risk of endometrial hyperplasia

 • SERM (ospemifene): for sx atrophy not relieved by nonpharm tx or not amenable to topical tx; adv effects incl ↑hot flashes



#Menopause #Diagnosis #Management #Amenorrhea #gynecology
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Account created for the MGH Internal Medicine Housestaff Manual "White Book" - https://stk10.github.io/MGH-Docs/WhiteBook-2019-2020.pdf
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