1. Complications of Menopause
Jianhong Zhou

2. Definition
Menopause is defined by 12 months of amenorrhea after the final menstrual period (FMP).
The median age of menopause is 51.4 years, with 90% becoming menopausal between the ages of 45 to 55 years of age.
Premature menopause is defined as the permanent cessation of menses occurring before 40 years of age.

3. Various physiologic and hormonal changes occur
A decrease in estrogen
Increase in FSH
Classic symptoms such as
Hot flashes
Night sweats
Mood swings
Vaginal dryness

4. How often and serious ? 10% of women will begin during perimenopause
50% will experience an increase in symptoms during menopause
Symptoms may last during the first year or two of menopause
Rarely do symptoms extend beyond the first 5 years of menopause

5. Etiology
Menopause is heralded by menstrual irregularity as the number of oocytes capable of responding to FSH and LH decreases
Anovulation becomes more frequent
LH and FSH levels gradually rise because of decreased negative feedback from diminished E production

6. Inhibin
Estradiol
Hypothalamus
Pituitary gland
Ovary=No gonadal E
FSH,LH
FSH,LH
Norepinephrine
Dopamine
Prostaglandins
Uterus
Vagina
Breast
Bone
Cardiovascular
system
Hot flashes
Insomnia
Depression
Osteoporosis
Atherosclerosis
Atrophy

7. Diagnosis
History
Physical exam
Confirmed by testing FSH levels

8. Diagnosis -History Average age of 51
Complaining of amenorrhea, vasomotor instability, sweats, mood changes, depression, dyspareunia, and dysuria
Disappear within 12 months generally
Remain for years

9. Diagnosis-PE Decrease in breast size and change in texture
Vaginal, urethral, cervical atrophy
Be consistent with decreased E

10. Diagnosis-FSH
If there is any question about the diagnosis, an elevated FSH is diagnostic of menopause
During the perimenopausal period, the FSH level may be increased or decreased.
FSH is best reserved for patients with a combination of amenorrhea or oligomenorrhea and menopausal symptoms

11. Pathogenesis Long-term consequences of the estrogen decrease
Osteoporosis -bone resorption accelerates
Atherosclerosis-increased risk for coronary artery disease

12. HRT and ERT
HRT –hormone replacement therapy-refers to the use of a combination of estrogen and progesterone to treat menopausal related symptoms in women who still have their uterus in situ
Menopausal symptoms are due to decreased E levels
The E component on HRT supplies the patient with an exogenous source of E and thereby treats the symptoms of menopause

13. HRT and ERT
Unopposed estrogen exposure can result in endometrial hyperplasia or cancer
Progestins must be used to decrease the risk of endometrial hyperplasia and cancer in women who still have a uterus in situ
Estrogen replacement therapy-ERT can be used for women with menopausal symptoms who have undergone a hysterectomy

14. HRT and ERT
The other major value of HRT is the prevention and treatment of osteoporosis
A important preventative measure—since 15% of women over age 50 will be diagnosed with osteoporosis and 50% with osteopenia
A woman can lose 20% of her original bone density in the first 5 to 7 years after menopause

15. HRT and ERT
The risks and benefits have been the center of numerous studies over the past few decades
Each patient’s symptoms, risk factors, and related risks and benefits should be individually evaluated

16. Contraindications to HRT
Chronic liver impairment
Pregnancy
Known estrogen-dependent neoplasm
History of thromboembolic disease
Undiagnosed vaginal bleeding

17. Additional therapeutic regimens
Alternative regimens for postmenopausal women who are unable or unwilling to take HRT, should be targeted toward the individual’s symptoms and treatment goals
Vasomotor flushes
Vaginal atrophy
The prevention and treatment for osteoporosis

18. How to treat vasomotor flushes
Be managed with clonidine
Selective serotonin reuptake inhibitors (SSRIs)

19. How to treat vaginal atrophy
Locally use with lubricants and moisturizers
Vaginal estrogen with only minimal systemic absorption

20. Prevention and treatment for osteoporosis
Calcium and vitamin D supplementation
Calcitonin
Raloxifene
Weight-bearing exercise
Reduction in smoking and in caffeine and alcohol intake

21. THANK YOU FOR YOUR ATTENTION
参考八年制教材
中华绝经学组围绝经期诊治指南（2009）
Postmenopausal Hormone Therapy （An Endocrine Society Scientific Statement 2010)
国际绝经协会关于绝经后激素治疗和中年女性健康预防策略的最新建议（2011）