management of menopausal symptoms journal

7/27/2019 Management of Menopausal Symptoms Journal

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Hendry Barka Pangidoan

406118064


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A 51-year old woman has frequent and

distressing hot flushes that interfere with herwork and sleep, and vaginal dryness that

makes sexual intercourse with her husband

uncomfortable. She is otherwise healthy. How

should her case be managed


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MenopausalTransition

Vasomotorsymptoms

Vaginalsymptoms


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Reproductive

Premenopausal

Menopausal


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Hot Flush is a sudden feeling of warmth that is generally

most intense over the face, neck, and chest.


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Asian

White

Black andLatina

Others:

Cigarette Smoking

Surgical Menopause

Physical activity

Body-mass index

Alcohol Consumption

Socioeconomic status


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Improve withinfew month

30%to 50%

Resolves within4 to 5 years

85% to 90%

Resolves Many yearsafter menopause

10% to 15%


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Hot Flushes resemble heat-dissipation response and may represent

abnormal thermoregulation by the anterior hypothalamus

The precise role of estrogen in the pathogenesis of this symptom is not

clear

Endogenous estrogen do not differ substantially betweenpostmenopausal women who have hot flushes and those who do not

have them

Hot flushes do not occur in women with gonadal dysgenesis unless

estrogen therapy is used and discontinues.


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Dryness Discomfort

Itching Dyspareunia

VaginalSymptoms


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About 30%

Up to 47%

Late Postmenopausal Period

Early Postmenopausal Period


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VaginalSymptoms Urologic

Symptoms


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Postmenopausal women with vaginal symptoms as

compared with premenopausal women have:

Decreased vaginal blood flow and secreations

Hyalinization of collagen Fragmentation of elastin

Proliferation of vaginal connective tissue

Vaginal fluid less acidic


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Vasomotor Symptoms

FSH and LH may be within the normal premenopausalrange during the meopausal transtition

Its not routinly recommended

Vaginal Symptoms

Elevated pH level in vaginal fluid and cytogenicanalysis of exfoliated cells from vaginal wall containingmore than 20% parabasal cells are corelated withmenopause.

But their use in the diagnosis of symptomatic vaginalatrophy has not been established


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Estrogens

Nonestrogenic Hormonal

Therapies

Other Presciption Drugs


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Vaginal estrogens

Vaginal moisturizer

Oral phytoestrogens

Vaginal Estrogens

Creams

Tablets

Estradiolreleasing ring


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The causes of hot flushes and vaginal atrophy remain

uncertain

Although many treatments have been evaluated

None have been proved to be both highlyeffective and safe


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FDA and American College of Obstetricians andGynecologists

Use postmenopausal therapy at the lowest dose and forthe shortest possible time for the treatment ofmenopausal symptoms

The North American Menopause Society

For Mild Hot Flushes Symptoms lifestyle changes eitheralone or combined with nonprescription remedy

For Mild to Severe Hot Flushes Symptoms hormontherapy as therapeutic standard

FDA, The North American Society, and TheSociety of Obstetricans and Gynaecologist ofCanada

Use of vaginal estrogens preparation when menopausalsymptoms are limited to the vagina


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vasomotor symptoms generally improve or resolve within a fewyears but that vaginal symptoms may not improve spontaneously

The lowest dose of estrogen that adequately controls symptomsshould be used

Given the natural history of vasomotor symptoms, it is reasonableto try discontinuing hormone therapy every 6 to 12 months. If

symptoms recur, restarting and then gradually tapering the doseor the number of days per week that hormones are used may behelpful

For vaginal symptoms alone, systemic estrogen therapy is notindicated. A vaginal moisturizer may provide adequate relief; ifnot, topical estrogen therapy should be used.


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From the Women's Health Clinical Research Center, University of California,

San Francisco, and the San Francisco Veterans Affairs Medical Center both in

San Francisco.

Address reprint requests to Dr. Grady at the Women's Health Clinical Research

Center, 1635 Divisadero St., Suite 600, San Francisco, CA 94115.


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management of menopausal symptoms journal

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