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MENOPAUSE & HORMONE THERAPY
Spontaneous/Natural menopause is the final menstrual period confirmed after 12 consecutive months of amenorrhea with no pathological cause.
Induced menopause is the permanent cessation of menstruation after bilateral oophorectomy (ie surgical menopause) or iatrogenic ablation of ovarian function (eg pelvic radiation therapy, chemotherapy).
Perimenopause/Menopause transition/Climacteric is the duration when menstrual cycle & endocrine changes occur a few years before and 12 months after the final menstrual period resulting from natural menopause.
Premature menopause is menopause before 40 years of age whether natural or induced while early menopause is spontaneous or induced menopause that occurs before the average age of natural menopause at 51 years or under 45 years of age.

Follow Up

  • Schedule follow-up visit within a few months (eg 3 months) of starting menopausal hormone therapy (MHT)
    • Monitor compliance, response and side effects especially bleeding
    • Counsel on expected bleeding patterns and need for regular breast self-examination
    • Adjust MHT if required
  • Patient should be evaluated yearly thereafter
    • Review risks versus benefits
    • Urinalysis and blood pressure (BP) at each visit
    • Cervical smears for all women with uterus
    • Every 2 years: Perform physical exam, lipid profile, liver function tests (LFTs), fasting glucose and mammogram if indicated
    • Perform bone mineral density (BMD) as required
  • If women experience recurrence of hot flushes after stopping ET, non-hormonal agents may be tried; if symptoms persist, MHT may be resumed at the lowest effective dose in select patients 
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