0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16
968 Menopause■Perimenopause usually lasts 4–5 y, but may last only 2 y
■On average, nulliparous women and smokers have earlier meno-
pause
Signs & Symptoms
■Perimenopause changes:
➣Change in menstrual flow & length of cycle
➣Risk of unintended pregnancy
■Vasomotor symptoms: hot flashes, day/night sweats (80%)
■Vaginal dryness/dyspareunia
■Other symptoms reported by midlife women:
➣Stiffness/soreness, insomnia/sleep disturbances, depression
(esp if prior history), urine leakage, changes in libido, headaches
and backaches, forgetfulness, palpitations, UTIs, fatigue
■Not associated with perimenopause/menopause: major depressive
disorder
tests
FSH levels (preferably several)
differential diagnosis
Premature ovarian senescence
management
What to Do First
■Topics to cover in counseling:
➣Hot flashes, day/night sweats
➣Vaginal dryness/dyspareunia
➣CHD
➣Osteoporosis
➣Estrogen/hormone replacement therapy (HRT):
Not indicated for routine therapy
Short-term use for hot flashes
Increased risk of breast cancer with progestin component of
HRT
Increased risk of thrombosisGeneral Measures
■Hot flashes, day/night sweats:
■Nonpharmacologic: dress in layers, identify and avoid triggers, aer-
obic exercise
■Pharmacologic: short-term estrogen/HRT, clonidine, herbal prepa-
rations/dietary supplements
■Vaginal dryness/dyspareunia: