Epidemiology

Etiology

Pathophysiology

Menstrual irregularities and amenorrhea

• �?Ovarian function from age-related ovarian follicle loss leads to:
  • �?Estrogen and progesterone levels �?loss of negative feedback on the pituitary gland �?�?GnRH levels �?�?FSH and LH levels (hypergonadotropic hypogonadism)
  • �?In anovulatory cycles
    • As the ovaries age, they become less responsive to gonadotropin stimulation.
• Ovarian function eventually ceases.
• Iatrogenic removal of the ovaries leads to abrupt cessation of ovarian function.

Vasomotor symptoms

• Hypothalamic thermoregulatory zone narrows �?small temperature changes trigger compensatory reactions
• �?Estrogen is associated with �?norepinephrine and �?serotonin

Genitourinary symptoms

• Hypoestrogenism �?vaginal and vulvar epithelial atrophy, as well as urethral and bladder atrophy
  • Estrogen has positive effects on collagen and the epithelial surface.

Clinical features

Menstrual abnormalities

• Irregular menses that gradually decrease in frequency until complete amenorrhea

Vasomotor symptoms of menopause (VMS)

• Increased sweating
• Hot flashes
• Heat intolerance
• Seen in �?75% of individuals during perimenopause and menopause
• On average, vasomotor symptoms last for �?7 years.

Other symptoms

• Osteoporosis
  • Develops at least 10-15 years after cessation of menses

Diagnostics

Supportive studies to confirm menopause

• FSH: ↑↑; however, levels widely fluctuate during perimenopause
• Estradiol: �?
• Rarely tested for as not routinely recommended: �?progesterone, �?inhibin B, and �?antimüllerian hormone

Studies to exclude differential diagnoses of menopause

• Pregnancy test: to rule out pregnancy as a cause of amenorrhea
• Prolactin: elevated in hyperprolactinemia
• LH: elevated in POI
• TSH: Both hypothyroidism and hyperthyroidism can cause menstrual irregularities.

Treatment