Menopause University of North Carolina at Chapel Hill绝经北卡罗来纳大学教堂山分校.pptVIP

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Menopause University of North Carolina at Chapel Hill绝经北卡罗来纳大学教堂山分校.ppt

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Menopause University of North Carolina at Chapel Hill绝经北卡罗来纳大学教堂山分校

The Menopause Anne Z. Steiner, MD, MPH Assistant Professor Reproductive Endocrinology and Infertility University of North Carolina at Chapel Hill Objectives Understand reproductive aging Physiology Stages Understand the physiologic changes and symptoms associated with menopause Discuss treatment options for conditions associated with menopause Define Premature Ovarian Failure Reproductive Aging Decline in reproductive potential Puberty → Peak reproduction → Decline in fertility → Anovulation (menstrual irregularity) → Menopause Due to ovarian aging (physiology) Progresses with the decline in oocyte/follicular pool Reproductive Aging Process begins in embryonic life. 20 weeks gestation - 6 - 7 million follicles. At birth - 1.5-2 million follicles At menarche - 300,000- 400,000 follicles Follicular atresia continues throughout life. Follicular loss accelerates when the total number of follicles is ~25,000 When follicles are sufficiently depleted (1000), menopause occurs. Reproductive Aging Stages of Reproductive Aging Reproductive Stage Stages of Reproductive Aging Perimenopause Follows period of declining fertility Precedes menopause Characterized by cycle irregularity (shortening then lengthening) increasing symptoms Duration 2 to 8 years (average 5 years) Diagnosing Perimenopause Clinical diagnosis based on menstrual cycle pattern. Early follicular phase FSH and symptoms may help solidify diagnosis. Rule out hypothyroidism, depression etc. Perimenopause -- Symptoms: Vasomotor instability (85%) Sleep disturbances Mood disturbances. Somatic symptoms: Fatigue, palpitations, headache, increased migraine, breast pain and enlargement. Oligo- ? Anovulation heavier or irregular cycles. Managing Perimenopause Goals: Patient education Prevention of endometrial cancer Individualized symptomatic relief Menstrual control Minimizing hot flashes Mood disturbances Managing Perimenopause Menopause Marks the end of reproductive life Cessation of menses for 12 months