A 53-year-old woman presents with symptoms of menopause including hot flashes, vaginal dryness, and irritability that started one year ago. Menopause is defined as the permanent cessation of menstruation that occurs naturally in women between ages 40-60, with a mean age of 51. It results from depletion of ovarian follicles leading to elevated FSH levels. Symptoms include amenorrhea, hot flashes, and effects of declining estrogen like risks to the reproductive, urinary, psychological, cardiovascular, and bone health such as osteoporosis. Hormone replacement therapy was previously advocated to prevent these effects but large prospective studies found increased health risks.

1. MENOPAUSE

2. “ You do not heal old age
You protect it;
You promote it;
You extend it.”
Sir James Ross

3. Case Detail
• A 53-Yr-Old complains of hot flashes, vaginal dryness & irritability.
Her symptoms started one year ago and getting worse. Her last gynae
exam was 2 years ago Mammogram was normal.

4. Life Expectation & Age of Menopause

5. Definition
• Age: 40-60 Yrs – Mean 51 Yrs 98% of women
Genetically determined
Unaffected by pregnancy or OCPs
Smokers: occurs 2 yrs earlier

6. Premature Menopause
• Age 30 – 40 yrs
1% of women
Mostly Idiopathic
Post: Radiation therapy
Post : Oophorectomy

7. Premature Ovarian Failure
Age < 30 Yrs
Rare
Consider
Autoimmune etiology
Y chromosome Mosaicism

8. Perimenopause
3 - 5 Yrs Proceeding Menopause
Menses become Anovulatory
Menses Decrease

9. Ovarian Follicles
• Intrauterine – 6 to 7 Millions
• Birth- 1.5 Millions
• Puberty- 4.5 Lakhs
• Menopause – All gone
No Follicles

10. Diagnosis Serially elevated
• FSH x 3 months
• Aetiology – Lack of follicles

11. Symptoms of MP
• Amenorrhea
• Hot Flashes

12. Effect of Estrogen deficiency

13. Symptoms of Menopause
• Reproductive Tract
• Urinary Tract
• Psychological
• Cardiovascular
• Bones

14. Significance of Osteoporosis

15. Normal Bone
Osteoporosis Bone

16. Osteoporosis

17. Changes in Spine
• DXA Scan

18. Bone Density loss with age - Max at 30 years
• Current Bone
• Rate of Bone

19. Hormone Replacement Therapy (MHT)
“Menopause is a hormone deficiency & totally
preventable. Now almost every women,
regardless of age, can safely live a full sex life for
her entire life”

20. Observational Studies – Nurses Health Study
• Questionnaires (ERT/EP RT)
• Conclusions – Good for Prevention (CVD)
• Secondary Prevention
• HERS- Heart Estrogenic Rep Therapy - Study Not Good

21. Faltering Faith in ERT
• Prospective Studies of (WHI)

22. Finding in WHI Study
• Bad Press
• ETP outcome