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Menopause and Hormonal Therapy

Epidemiology:

The mean age of menopause is 51; it occurs before age 40 in 5% of women

Average length of perimenopause is 4 years

Earlier menopause is seen in cigarette smokers, those living at higher altitude estrogen

Physiology:

Premenopausal women after age 40 often have shorter cycles which lengthen just before.

Physiology

Iincreased ovarian resistance to FSH

Increased FSH levels (diagnostic level > 40)

Decreased estrogen

Estrone (less potent than estradiol) is the major circulating estrogen menopaus

Symptoms:

Vasomotor instability - "hot flashes"

Affect 80% of women

Less severe in obese women

Hormonal Therapy Estrogen

Urogenital atrophy

decreased lubrication

dyspareunia

Hormones Estrogen

UTIs

Mood disorders Hormonal Therapy Estrogen

No increase in major depression, ?mild symptoms of depression may sometimes occur.

Hot flashes may interfere with sleep

Treatment of symptoms:

Estrogen 95 % effective