Optimal Treatment for the Surgically Induced Menopausal Patient对于手术引起的绝经期患者最佳的治疗.ppt

Optimal Treatment for the Surgically Induced Menopausal Patient By Kerrie Hickman Surgically Induced Menopause=Hysterectomy with Bilateral Oophorectomy Today approximately 600,000 hysterectomies performed in U.S. Most common age group = 40-44 years old, followed by 35-39. More than ? of these women also have both ovaries removed. Hysterectomies are the second most frequent major surgical procedure among reproductive-aged women (2nd to C-section). ~1/3 of American women have their uterus removed before the age of 50. (3 most common conditions leading to surgery were fibroid tumors, endometriosis, uterine prolapse. Mean Steroid Levels in Women(pg/mL) Menopausal Complaints Hot flashes Night sweats Sex organ atrophy (breast and vaginal) Urogenital changes Sexual dysfunction decreased libido Vasomotor Symptoms Night Sweats -90% of surgically induced menopausal women experience hot flashes compared to the 40% of natural menopause. -Reports also suggest they are more frequent and/or severe. Postmenopausal Urogenital Changes Vaginal atrophy of labia minora and majora Vaginal canal shrinks in length and diameter pH of vagina increases (allowing more pathogenic bacterial colonization Decrease in vaginal lubrication Vaginal mucosa becomes thin and losses elasticity Distance from urethral opening to vaginal introitus reduces due to tissue atrophy = increase in UTI’s, BV, vaginal dryness, dyspareunia Increase in Disease Associated with Surgical Menopause Cardiovascular disease/MI Stroke Osteoporosis Clinical Depression The Younger the Woman, the Greater the Concern: Cardiovascular Implications for Younger, Surgically Menopausal Women Relative Risk of Nonfatal MI Management Hormonal, non-hormonal, or combination therapy Estrogen only Lowest dose possible to minimize risks (may need to start at a moderate dose following surgery) Recent studies suggest low dose systemic estrogens combined with vagi