2,171
edits
Changes
Jump to navigation
Jump to search
Line 255:
Line 255: − + − + − Investigations+ − • Vaginal cytology: showing maturation index of at least 10/85/5 (features of low estrogen)+ − • Serum estradiol: <20 pg/ml+ − • Serum Follicle Stimulating Hormone (FSH) and Luteinizing hormone (LH) :>40mIU/ml (three values at weeks interval required)+ − + − + + + + + + + + + − • Oral estrogen regime- for those who underwent hysterectomy+ − • Estrogen and cyclic progestin – for those with intact uterus+ − • Continuous estrogen and progestin therapy-prevents endometrial hyperplasia+ − • Transdermal administration+ − • Subdermal implants+ − • Percutaneous estrogen gel+ − • Transdermal patch+ − • Vaginal cream+ − • Progestins- in patients with a history of breast carcinoma or endometrial carcinoma+ − • Levonorgestrel intrauterine system(LNG-IUS)+ − • Tibolone, Testosterone, parathyroid hormone are also used.+ + + + + + + + + + + + + − + + + − + − • Premature menopause: Occurrs before the age of 40 years.+ − • Delayed menopause: Fails to occur even beyond 55 years.+ − • Artificial menopause: Permanent cessation of ovarian functions done by artificial means.+ − + − • Menstruating women with bilateral oophorectomy experience the symptoms of menopause+ − • Post-hysterectomy cases+ − + − • Ovarian functions may get suppressed by external gamma radiation.+ − • Intra cavity introduction of radium can destroy the endometrium and depress ovarian functions.+ + + + + + + + + + +
→Contemporary approach
==Contemporary approach==
==Contemporary approach==
Diagnosis of menopause:
===Diagnosis of menopause:===
A woman is noted to have attained menopause only retrospectively. It is diagnosed when there is cessation of menstruation for 12 consecutive months in a woman of the climacteric period.
A woman is noted to have attained menopause only retrospectively. It is diagnosed when there is the cessation of menstruation for 12 consecutive months in a woman of the climacteric period.
'''Investigations'''
Management
*Vaginal cytology: showing maturation index of at least 10/85/5 (features of low estrogen)
Hormone Therapy (HT)
*Serum estradiol: <20 pg/ml
*Serum Follicle Stimulating Hormone (FSH) and Luteinizing hormone (LH) : >40mIU/ml (three values at weeks interval required)
===Management===
'''Hormone Therapy (HT)'''
It is indicated to overcome the short-term and long-term consequences of estrogen deficiency.
It is indicated to overcome the short-term and long-term consequences of estrogen deficiency.
It is administered in different forms like:
It is administered in different forms like:
*Oral estrogen regime- for those who underwent hysterectomy.
*Estrogen and cyclic progestin – for those with intact uterus.
*Continuous estrogen and progestin therapy-prevents endometrial hyperplasia
*Transdermal administration
*Subdermal implants
*Percutaneous estrogen gel
*Transdermal patch
*Vaginal cream
*Progestins- in patients with a history of breast carcinoma or endometrial carcinoma
*Levonorgestrel intrauterine system(LNG-IUS)
*Tibolone, Testosterone, parathyroid hormone are also used.
Hormone therapy has many risks like endometrial cancer, breast cancer, venous thromboembolic disease, coronary heart disease, alteration in lipid metabolism etc. So, it is to be used with lowest effective dose and for a short period of time.
Hormone therapy has many risks like endometrial cancer, breast cancer, venous thromboembolic disease, coronary heart disease, alteration in lipid metabolism etc. So, it is to be used with lowest effective dose and for a short period of time.
Non-hormonal Treatment
'''Non-hormonal Treatment'''
It includes a nutritious diet, exercise, lifestyle modification, supplementation of calcium, vitamin D, vitamin E etc.
It includes a nutritious diet, exercise, lifestyle modification, supplementation of calcium, vitamin D, vitamin E etc.
Abnormal Menopause:
===Abnormal Menopause===
*Premature menopause: Occurrs before the age of 40 years.
a) Surgical menopause-
*Delayed menopause: Fails to occur even beyond 55 years.
*Artificial menopause: Permanent cessation of ovarian functions done by artificial means.
b) Radiation menopause-
'''a) Surgical menopause-'''
*Menstruating women with bilateral oophorectomy experience the symptoms of menopause.
*Post-hysterectomy cases
'''b)Radiation menopause-'''
*Ovarian functions may get suppressed by external gamma radiation.
*Intra cavity introduction of radium can destroy the endometrium and depress ovarian functions.
==Current Research==
==Current Research==
• The modified Kupperman index, Menopause Rating Scale(MRS), MENQOL Questionnaire, etc. are the most widely used and internationally accepted scales used for research related to menopause and associated conditions.
• The modified Kupperman index, Menopause Rating Scale(MRS), MENQOL Questionnaire, etc. are the most widely used and internationally accepted scales used for research related to menopause and associated conditions.