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Source: Kalantaridou SN, Borgelt LM, Dang DK, Calis KA. Hormone therapy in women. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=146067309. Accessed May 17, 2017.
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CONDITION/DISORDER SYNONYMS
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Climacteric.
Change of life.
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May be due to normal aging process, surgery (total abdominal hysterectomy, bilateral oophorectomy), medications (eg, chemotherapy), or pelvic irradiation.
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Loss of ovarian follicular activity; postmenopausal ovaries no longer primary site of estradiol or progesterone synthesis.
As women age, follicle-stimulating hormone (FSH) rises and ovarian inhibin declines. When ovarian function ceases, serum FSH concentrations are >40 IU/L. Menopause characterized by:
10- to 15-fold increase in circulating FSH concentrations compared with concentrations of FSH in follicular phase.
4- to 5-fold increase in luteinizing hormone (LH)
>90% decrease in circulating estradiol concentrations.
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Median age at onset in the United States: 51 years (but can vary from 40 to 58 years).
Women who have undergone hysterectomy must rely on symptoms to estimate the actual time of menopause and are more likely to have earlier menopause.
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CLINICAL PRESENTATION
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Serum FSH levels.
Thyroid function tests.
Iron stores.
Lipid profile.
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DIFFERENTIAL DIAGNOSIS
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Pregnancy.
Premature ovarian failure.
Hypothyroidism or hyperthyroidism
Hyperprolactinemia.
Polycystic ovary syndrome.
Hypothalamic amenorrhea (eg, stress, weight change, exercise)
Other endocrine causes (eg, Cushing’s syndrome, Addison’s disease)
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TREATMENT: GENERAL APPROACH
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TREATMENT: NONPHARMACOLOGIC THERAPY
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