Chapter 171 Menopause
INTRODUCTION
Description: Menopause is an endocrinopathy caused by the loss of normal ovarian steroidogenesis because of age, chemotherapy, radiation, or surgical therapy. (An endocrinopathy is the loss of an endocrine function with adverse health consequences.)
ETIOLOGY AND PATHOGENESIS
Causes: Loss of estrogen production because of surgery, chemotherapy (alkylating agents), radiation, or natural cessation of ovarian function (menopause).
CLINICAL CHARACTERISTICS
WORKUP AND EVALUATION
Laboratory: Usually not necessary. When the diagnosis of ovarian failure must be confirmed, measurement of serum follicle-stimulating hormone (FSH) is sufficient. Levels of greater than 100 mIU/mL are diagnostic, although lower levels (40 to 50 mIU/mL) may be sufficient to establish a diagnosis when symptoms are also present. Serum estradiol levels may be determined (generally less than 15 pg/mL) but are less reliable as a marker of ovarian failure. A pregnancy test is always indicated in women who are perimenopausal and sexually active and not using contraception.
Special Tests: A vaginal maturation index may be obtained but is generally not required for diagnosis. Bone densitometry may be indicated for those at special risk. When noncyclic bleeding occurs in these patients, endometrial biopsy should be strongly considered. Women younger than age 30 years who have ovarian failure should have a karyotype performed.
MANAGEMENT AND THERAPY
Nonpharmacologic
General Measures: Health maintenance, annual mammogram, annual pelvic and rectal examinations, thyroid and cholesterol screening every 5 years or as indicated, tetanus booster shot every 10 years, pneumococcus vaccine as indicated.
Specific Measures: For symptom relief: systemic estrogen (estrogen/progestin) therapy. (Less than 1% of women do not benefit from therapy.) Topical estrogen supplements.
Activity: No restriction, weightbearing activity to promote bone health, cardiovascular fitness training/maintenance.
