Menopause resident survival guide: Difference between revisions
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==Treatment== | ==Treatment== | ||
Shown below is an algorithm summarizing the treatment of | Shown below is an algorithm summarizing the treatment of [[menopause]]. <ref>{{cite web |url=https://www.aafp.org/afp/2014/0901/p338.html |title=ACOG Releases Clinical Guidelines on Management of Menopausal Symptoms - Practice Guidelines - American Family Physician |format= |work= |accessdate=}}</ref> <ref>{{cite web |url=https://www.nichd.nih.gov/health/topics/menopause/conditioninfo/treatments |title=What are the treatments for other symptoms of menopause? | NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development |format= |work= |accessdate=}}</ref> | ||
{{familytree/start | {{familytree/start}} | ||
{{familytree | | | | | | | | | {{familytree | | | | | | | | | | | | | | B01 | | | | | | | | | | |B01=[[Menopausal]] symptoms}} | ||
{{familytree | | | | | | {{familytree | | |,|-|-|-|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|-|.| | }} | ||
{{familytree | | | | {{familytree | | C01 | | | | | | | | | | C02 | | | | | | | | | C03 |C01=[[Genitourinary]]<br>syndrome of [[menopause]] <br> (vaginal dryness, itching,<br> dyspareunia, urinary incontinence)|C02= [[Vasomotor]] symptoms <br> (hot flashes, night sweats)|C03= Sleep problems}} | ||
{{familytree | | | |!| | | | | | | | | |!| }} | {{familytree | | |!| | | | | | | | | | | |!| | | | | | | | | | |!| |}} | ||
{{familytree | | | | {{familytree | | D01 | | | | | | | | | | D02 | | | | | | | | | D03 |D01= Water based lubricants <br> Ospemifene <br> Vaginal oestrogen|D02= Based on patient preference |D03= Regular exercise, <br> Sleep hygiene, <br> Avoid alcohol and caffeine}} | ||
{{familytree | |,|-|^|.| | | | | | | | |!| }} | {{familytree | | | | | | | | | |,|-|-|-|-|^|-|-|-|-|.| | | | | | | | | |D05=D05}} | ||
{{familytree | | {{familytree | | | | | | | | | E01 | | | | | | | | E02 | | | | | | | | |E01=Life style<br> modification |E02=Medical therapy|}} | ||
{{familytree | |!| | | | | | | | | |,|-|^|.| }} | {{familytree | | | | | | | | | |!| | | | | |,|-|-|-|^|-|-|-|.| | | |}} | ||
{{familytree | | {{familytree | | | | | | | | | F01 | | | | F02 | | | | | | F03 | | | | | |F01= -Avoid [[smoking]], [[caffeine]], [[alcohol]]<br> -Use of fan, cool bedroom, cool shower<br> -Relaxation exercises |F02= [[Hormonal]] replacement<br>therapy | F03=[[Non-hormonal]]<br>therapy }} | ||
{{familytree | | | | | | | | | | |!| | | | |!| }} | {{familytree | | | | | | | | | | | | | | | |!| | | | | | | |!| | | |}} | ||
{{familytree | | | | | | | | | | | {{familytree | | | | | | | | | | | | | | | G01 | | | | | | G02 | | | | |G01= Post [[hysterectomy]] status| G02= When [[hormonal]] use<br> is contraindicated <br> (History of [[breast cancer]],<br> [[Venous thromboembolism]],<br> Undiagnosed [[vaginal]] bleeding, etc.}} | ||
{{familytree | | | | | | | | | | | | |,|-|-|^|-|-|.| | | | |!| | | |}} | |||
{{familytree | | | | | | | | | | | | H01 | | | | H02 | | | H03 | | | | |H01= [[Hysterectomised]]| H02= [[Uterus]] in-situ |H03= [[Paroxetine]]([[SSRI]]) <br>[[Clonidine]] <br>[[Gabapentin]] <br>Clinical [[hypnosis]] }} | |||
{{familytree | | | | | | | | | | | | |!| | | | | |!| | | | | | | | |}} | |||
{{familytree | | | | | | | | | | | | I01 | | | | I02 | | | | | | | | |I01= [[Oestrogen]] alone | I02= [[Oestrogen]]+[[Progesterone]] }} | |||
{{familytree/end}} | {{familytree/end}} | ||
Revision as of 07:00, 8 February 2021
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayeesha Kattubadi, M.B.B.S[2]
Synonyms and keywords:
Overview
This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
Common Causes
- Natural menopause
- Premature ovarian failure or Early menopause
- Surgical menopause
- Chemotherapy and radiation induced menopause
Diagnosis
Shown below is an algorithm summarizing the diagnosis of menopause. [5] [6] [7]
| Presence of Menopausal Symptoms + irregular/absent menstrual periods | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Age | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ≥45 years | 40-45 years | ≤40 years | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Uterus | Rule out other causes like pregnancy, hyperthyroidism, prolactinoma | Rule out medical and surgical causes of amenorrhea/oligomenorrhe | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Absent | Present | Normal | Abnormal | Measure FSH and Estradiol two samples 4-6 weeks apart | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Menopause diagnosed based on symptoms | Irregular periods+ menopausal symptoms | Amenorrhea>12 months ± menopausal symptoms | Amenorrhea > 12 months | Menopause ruled out | FSH elevated Estradiol depressed | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Perimenopause | Menopause | Early menopause | Premature ovarian failure | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of menopause. [8] [9]
| Menopausal symptoms | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Genitourinary syndrome of menopause (vaginal dryness, itching, dyspareunia, urinary incontinence) | Vasomotor symptoms (hot flashes, night sweats) | Sleep problems | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Water based lubricants Ospemifene Vaginal oestrogen | Based on patient preference | Regular exercise, Sleep hygiene, Avoid alcohol and caffeine | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Life style modification | Medical therapy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| -Avoid smoking, caffeine, alcohol -Use of fan, cool bedroom, cool shower -Relaxation exercises | Hormonal replacement therapy | Non-hormonal therapy | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Post hysterectomy status | When hormonal use is contraindicated (History of breast cancer, Venous thromboembolism, Undiagnosed vaginal bleeding, etc. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hysterectomised | Uterus in-situ | Paroxetine(SSRI) Clonidine Gabapentin Clinical hypnosis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Oestrogen alone | Oestrogen+Progesterone | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Do's
- The content in this section is in bullet points.
Don'ts
- The content in this section is in bullet points.
References
- ↑ Rodriguez M, Shoupe D (2015). "Surgical Menopause". Endocrinol Metab Clin North Am. 44 (3): 531–42. doi:10.1016/j.ecl.2015.05.003. PMID 26316241.
- ↑ Secoșan C, Balint O, Pirtea L, Grigoraș D, Bălulescu L, Ilina R (2019). "Surgically Induced Menopause-A Practical Review of Literature". Medicina (Kaunas). 55 (8). doi:10.3390/medicina55080482. PMC 6722518 Check
|pmc=value (help). PMID 31416275. - ↑ Torrealday S, Kodaman P, Pal L (2017). "Premature Ovarian Insufficiency - an update on recent advances in understanding and management". F1000Res. 6: 2069. doi:10.12688/f1000research.11948.1. PMC 5710309. PMID 29225794.
- ↑ Liem GS, Mo FK, Pang E, Suen JJ, Tang NL, Lee KM; et al. (2015). "Chemotherapy-Related Amenorrhea and Menopause in Young Chinese Breast Cancer Patients: Analysis on Incidence, Risk Factors and Serum Hormone Profiles". PLoS One. 10 (10): e0140842. doi:10.1371/journal.pone.0140842. PMC 4613138. PMID 26485568.
- ↑ Stuenkel, Cynthia A.; Davis, Susan R.; Gompel, Anne; Lumsden, Mary Ann; Murad, M. Hassan; Pinkerton, JoAnn V.; Santen, Richard J. (2015). "Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology & Metabolism. 100 (11): 3975–4011. doi:10.1210/jc.2015-2236. ISSN 0021-972X.
- ↑ https://www.nice.org.uk/guidance/ng23/chapter/Recommendations
- ↑ https://www.menopause.org.au/hp/gp-hp-resources/300-diagnosing-menopause
- ↑ "ACOG Releases Clinical Guidelines on Management of Menopausal Symptoms - Practice Guidelines - American Family Physician".
- ↑ "What are the treatments for other symptoms of menopause? | NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development".