menopause%20-and-%20hormone%20therapy
MENOPAUSE & HORMONE THERAPY
Treatment Guideline Chart

Menopause is associated with decreased estrogen production which leads to vasomotor symptoms and vulvovaginal atrophy. The woman may experience hot flushes, night sweats, dyspareunia or vaginal dryness. Spontaneous or natural menopause occurs when the final menstrual period is 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).

 

Menopause%20-and-%20hormone%20therapy Signs and Symptoms

Definition

Spontaneous/Natural Menopause

  • Final menstrual period confirmed after 12 consecutive months of amenorrhea with no pathological cause

Induced Menopause

  • Permanent cessation of menstruation after bilateral oophorectomy (eg surgical menopause) or iatrogenic ablation of ovarian function (eg pelvic radiation therapy, chemotherapy)

Perimenopause/Menopause Transition/Climacteric

  • Duration when menstrual cycle and endocrine changes occur a few years before and 12 months after the final menstrual period resulting from natural menopause
  • Menopausal symptoms that occur in women >45 years of age

Premature Menopause

  • Menopause before or at 40 years of age whether natural or induced
  • Premature ovarian failure is ovarian insufficiency before 40 years of age resulting in permanent or induced amenorrhea

Early Menopause

  • Spontaneous or induced menopause that occurs before the average age of natural menopause at 51 years or <45 years

Early Postmenopause

  • Occurs within 5 years after the final menstrual period

Signs and Symptoms

  • Menopause is associated with decreased estrogen production which leads to vasomotor symptoms and genitourinary syndrome of menopause (GSM) [eg urogenital atrophy which includes vaginal dryness, dyspareunia, painful urination, urinary urgency and recurrent urinary tract infections (UTIs)]

Menopausal Symptoms

Related to Hormonal Status

  • Hot flushes
  • Night sweats
  • Dyspareunia
  • Vaginal dryness

Potentially Related to Hormonal Status

  • Lack of energy, fatigue, sleep disturbances, insomnia
  • Depression, anxiety, mood swings, memory loss
  • Joint and muscle pain or stiffness, backache
  • Urinary incontinence
  • Headaches
  • Weight gain

Not Related to Hormonal Status 

  • Major depression

Risk Factors

Fracture and Osteoporosis

The more risk factors that are present, the greater the risk of fracture

  • May use Fracture Risk Assessment Tool (FRAX™), the World Health Organization (WHO) fracture assessment tool

Non-modifiable

  • Previous history of fracture as an adult
  • History of fracture in 1st-degree relative
  • Advanced age [low body weight and older age (Osteoporosis Self-Assessment Tool for Asians or OSTA)]
  • Poor health/frailty
  • Ethnic group (Asians generally have lower risk compared to Caucasians)
  • Early natural or surgical menopause before 45 years or prolonged premenopausal amenorrhea >1 year
  • Genetic diseases: Cystic fibrosis, osteogenesis imperfecta, Ehler-Danlos, hemochromatosis, Marfan syndrome

Modifiable

  • Recurrent falls
  • Decreased body weight (<125 lb or <57.6 kg)
  • Impaired vision
  • Medical conditions: Rheumatoid arthritis, estrogen deficiency, vitamin D deficiency due to lack of sunlight exposure or low intake, thyrotoxicosis, prolonged Levothyroxine intake, or multiple myeloma
  • Cigarette smoking
  • Excessive alcohol (≥3 drinks/day) and caffeine intake
  • Low calcium (Ca) intake, excessive salt or vitamin A intake
  • Oral glucocorticoid use ≥5 mg/day of Prednisone for ≥3 months
  • Sedentary lifestyle (lack of physical activity)
  • Secondary osteoporosis
  • Lack of sun exposure
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