Introduction
??: 1? ?? ??? ??? ??? ??
?? ???: ??? ?? ?, ???? ??? ??
??? 3?? ??: TSH, Prolactin, hCG
Physiology
- Inhibin ??? FSH ? (>40 ?? ?? ??) LH?? ??
- ?? ???? Estrone(E1)??? ??? ?? ? ???? E1 ?? (e.g. PCOS) ? HPO axis ???
- P ??, androgen ??.
- ?? ???? ????? AMH ?
- E ??? ?? ???? ??
- ?????? ??? ??, ??, ???
- ??? collagen & ?? ?? ?, ????, Alzheimer, CVD ?
| Vasomotor Sx | 75%, ? ??. ???? hot flash – E? withdrawal ??? ??? |
| ????? ?? | ????, ????, ???, ??? ? |
| ???? | ????? ???? ??? ? ?? ???. |
Health concerns after menopause
Vasomotor symptoms
Urogenital atrophy
- Symptoms
- Vulvovaginal dryness, irritation, pruritus
- Dyspareunia
- Vaginal bleeding
- Urinary incontinence, recurrent UTI
- Mimicking a UTI
- D/t the proximity of the bladder to the vaginal epithelium
- The bladder trigone and urethral epithelium may also atrophy, resulting in dysuria and urinary frequency.
- Pelvic pressure
- Physical examination
- Narrowed introitus
- Pale mucosa, ?elasticity, ?rugae
- Petechiae, fissures
- Loss of labial volume
- Minimal vaginal discharge with a pH >4.5 (d/t decreased lactic acid production from low glycogen content)
- Treatment
- Vaginal moisturizer & lubricant
- Topical vaginal estrogen
Osteoporosis
Cardiovascular disease
Breast cancer
Alzheimer’s disease
Hormone therapy use
The only current indication is vasomotor symptoms in women age <60 who have undergone menopause within the past 10 years.
- Advantages
- ?Vasomotor symptoms/????? ??/????
- ??, ??? ????
- ? cholesterol, LDL ?, HDL ?
- ???? CVD risk? – ???? ?? ? ?? ??. E ????? ????.
- Contraindications
- History of coronary heart disease, thromboembolism, TIA or stroke
- Breast cancer and endometrial cancer.
- Method
- ?? ??? ??: E only (?? ??? ????)
- ??? continuous E+P? ??. Irregular bleeding ???? cyclic??.
- ???: E – 1~25, P – 14~25 ? ??? ??? ?? ??
- ???: E: ????? ??, ??? ??? ??
- Alternative
- Vasomotor Sx? ??? SSRI, SNRI, gabapentin
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