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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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