As menopause refers to the physiological or iatrogenic cessation of menses (amenorrhea) due to ovarian removed. The symptoms are hot flashes and vulvovaginal atrophy. The diagnosis is made clinically: the absence of menses for 1 year. The symptoms can be treated (eg. As lifestyle change, complementary and alternative medical methods and / or hormone therapy).
In the US, the average age is in the physiological menopause 52 years. Factors such as smoking, living at high altitude and malnutrition can lower the age.
As menopause refers to the physiological or iatrogenic cessation of menses (amenorrhea) due to ovarian removed. The symptoms are hot flashes and vulvovaginal atrophy. The diagnosis is made clinically: the absence of menses for 1 year. The symptoms can be treated (eg. As lifestyle change, complementary and alternative medical methods and / or hormone therapy). In the US, the average age is in the physiological menopause 52 years. Factors such as smoking, living at high altitude and malnutrition can lower the age. As perimenopause be several years before (the duration varies considerably) and the year after the last menses referred. Usually it is the stage with the most symptoms. The menopause (the years during perimenopause, leading to the last menstrual period) is characterized by changes in menstrual pattern. Physiology With age, the ovaries increases their ability to Hypophysengonadotropine, follicle stimulating hormone (FSH) and luteinizing hormone (LH) to respond decreases. Initially, this leads to the shortening of the follicular phase (with ever shorter and less regular menstrual cycles), fewer ovulations and decrease in the production of progesterone (Simplified representation of the cyclic changes of Hypophysengonadotropinen, estradiol (E2), progesterone (P) and the endometrium during the normal menstrual cycle.). It comes to LOOP (double ovulation and luteal out-of-phase) -Ereignissen (d. H. Premature follicle due to FSH increase during the luteal phase), and occasionally the estradiol levels are elevated. The number of viable follicles decreases; Finally, the follicles no longer react; they only produce little estradiol. Estrogens are also formed in the peripheral tissues (eg. As fat, skin) from androgens (z. B. androstenedione, testosterone). The total concentration of estrogens is now much lower and estrone estradiol replaced as the most common estrogen. The menopause, the Androstendionspiegel falls by half, but the testosterone loss that begins in young adults accelerated during menopause not because postmenopausal the stroma of the ovary and the adrenal gland continues to produce significant amounts of it. Decreased levels of inhibin and estrogen from the ovary, which inhibit the release of LH and FSH from the pituitary gland, leading to a substantial increase in LH and FSH levels in the circulating blood. A rapid bone loss occurs during the first two years after the estrogen loss. After this phase of accelerated bone loss of age-related bone loss in women is similarly high as in men. Of premature failure of the ovaries (primary ovarian failure) is defined as the cessation of menses due to ovarian failure nichtiatrogenischen before age 40 and without medical intervention. It is assumed that genetic factors contribute to this. Symptoms and signs of menses changes usually begin between 40 and 50 years, first varies the cycle length. A persistent difference in consecutive menstrual cycle lengths of ? 7 days defines an early menopause. Discharging cycles ? 2 defines the late menopause. Significant fluctuations in estrogen levels are probably partly responsible for the perimenopausal symptoms and ailments such. As breast tenderness changes in menstrual bleeding moodiness aggravation of menstruation-related migraine Symptoms may occur to> 10 years 6 months; in the expression they vary from unnoticeable to very strong. Vasomotor symptoms as hot flashes and night sweats due to vasomotor instability occur in 75-85% of women before and put usually one before the cessation of menses. Hot flashes adhere to for> 1 year at the most women in 50%> 12 years 10% The women experience> 4 years a heat or heat sensation, sweating, sometimes very strong; the core body temperature rises there. The skin, v. a. on the face, head and neck, able to turn red and feel warm. A hot flash episode that lasts 30 seconds to 5 minutes, shivering can follow. In sleep hot flashes can occur as night sweats. The mechanism of hot flashes is unknown, but is believed to be due to changes in thermoregulation in the hypothalamus. The hearing ‘comfort range of Körperkernemperatur decreases; Therefore, a very small increase in core body temperature to a heat emission in the form of hot flashes führen.Vaginale symptoms can already These symptoms include dryness, dyspareunia and occasional irritation and itching. With decreasing estrogen production, the mucous membranes of the vulva and vagina become thinner, drier, more brittle and less elastic and the vaginal wrinkles lost. The urogenital syndrome Menopauseumfasst and vaginal symptoms as well as symptoms of the urethra and bladder, including urinary urgency, dysuria and frequent symptoms HWIs.Neuropsychiatrische Neuropsychiatric changes (eg. As poor concentration, memory loss, depression symptoms, anxiety) can temporarily accompany the menopause. Repeated night sweats attacks can contribute insomnia fatigue, irritability and lack of concentration by the sleep stören.Weitere symptoms Menopause is a normal, healthy phase in a woman’s life, but with which every woman can make her own experiences. For severe symptoms or when rarer symptoms such as joint pain and other pain, quality of life may decrease. Some women (z. B. those with endometriosis, dysmenorrhea, menorrhagia, premenstrual syndrome or menstrual migraine), quality of life improves after menopause. Diagnosis Clinical Investigation Rarely FSH levels The diagnosis is made clinically. A perimenopause is likely if the woman has reached an appropriate age and shows some typical of the perimenopause symptoms and discomfort. However, a pregnancy should be considered. If a woman over 12 months no menses, menopause is confirmed. A pelvic examination is performed; a vulvovaginal atrophy speaks for diagnosis. Each pathological change must be clarified (Space-occupying processes in the pelvis: Clarification). FSH measurements are possible but rarely necessary, except perhaps in hysterectomised patients and women who are actually too young for menopause. Regularly increased concentrations confirm the menopause. Women in postmenopausal increased risk of fractures (z. B. after the Fracture Risk Assessment Tool, FRAX) and all women> 65 years of age should be tested for osteoporosis. Treating lifestyle change Complementary and alternative medicine hormone Other neuroactive drugs Treatment is symptomatic (z. B. relief of hot flushes and the symptoms by vulvovaginal atrophy). Hormone therapy (estrogen, a progestin or both) is the most effective treatment for menopausal symptoms. It helps women to cope with the changes coming toward them when the physiological causes of menopause and possible symptoms and findings are discussed with them. Lifestyle modification With hot flashes, can help the following: Avoiding triggers (. Eg bright lights, duvets, predictable emotional reactions) The cooling of the environment (. Reduce eg the thermostat, fans use) Wearing clothes in layers, each can be removed as needed, can help with non-prescription vaginal lubricants and moisturizers vaginal dryness can be alleviated. can of regular intercourse or other vaginal stimulation to help vaginal function to preserve complementary and alternative medicine valerian, other herbal supplements and over the counter products do not seem to be helpful. Soy protein showed different results in studies; However, a soy product, S-equol, hot flashes is designed to prevent. Dehydroepiandrosterone (DHEA) can relieve vaginal dryness and other symptoms of vaginal atrophy; It is being studied as treatment for these symptoms. The effectiveness of regular exercise, of “paced respiration” (special breathing technique with slow, deep breathing) or relaxation techniques for hot flashes is controversial; However, exercise and relaxation techniques can improve sleep. The effectiveness of acupuncture has not been proven. Because in a study could alleviate hypnosis hot flashes, they may for open-minded women recommended werden.Neuroaktive substances Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) and gabapentin minderten in structured, randomized controlled trials, hot flashes default. A low dose of paroxetine can be used especially in hot flashes. Hormone therapy, however, is more effective. as all these drugs. Hormone hormone therapy (estrogen, a progestin or both) is the most effective treatment of menopausal symptoms. It is used for moderate to pronounced hot flashes and, in combination with an estrogen, the symptoms vulvovaginal atrophy. Hormone therapy increases on many quality of life by alleviating symptoms; however, it does not bear in asymptomatic women to improve the quality of life and is therefore given not routinely postmenopausal women. Is a hormone therapy for the treatment of menopausal symptoms necessary, the lowest dose should be used for the shortest time necessary. Also, hormone therapy is not for the prevention or treatment of chronic diseases (eg. As coronary heart disease, dementia, osteoporosis) is recommended. Choice of hormone therapy in women after hysterectomy should be given sole estrogens, either oral, transdermal (patch, lotion, spray or gel) or vaginally. Treatment should be initiated at the lowest dose; as required it is increased every 2 to 4 weeks. The dosage depends on the preparation. Low doses contained 0.3 mg p.o. once / day (conjugated equine estrogens or synthetic) 0.5 mg p.o. 1 times daily (oral estradiol) 0.025 mg once / day (estradiol patch) women with a uterus must also take a progestin with estrogen intake, because the sole administration of estrogen increases the risk of endometrial cancer. Progestin along with estrogen is taken continuously (i. E. Daily) or sequentially (to 12-14 consecutive days every 4 weeks). The dose is medroxyprogesterone acetate: daily administration in a dose of 2.5 mg and sequential administration in a dose of 5 mg. Micronized progesterone (a natural and not a synthetic progesterone): 100 mg for daily administration and 200 mg for sequential administration. Bleeding by discontinuation of the progestogen are less frequent with continuous therapy. Estrogen-gestagen combination preparations are available as tablets (z. B. 0.3 mg conjugated equine estrogens plus 1.5 mg of medroxyprogesterone acetate 1 time / day) or (as a patch z. B. 0.045 mg estradiol plus 0.015 mg of levonorgestrel 1 time / day) available. Are only vaginal symptoms before, a low-dose vaginal estrogen therapy is preferred. For the treatment of vaginal symptoms topical administrable preparations (eg. As creams, vaginal tablets or rings) can be more effective than oral forms. Vaginal tablets or rings, the estradiol in a low dosage (z. B. 10 ug for tablets, 7.5 micrograms for rings) include, give off less estrogen to the systemic circulation. Vaginal administrable estrogen should be administered at the lowest recommended dose, as higher doses can just give much estrogen as oral or transdermal preparations; Women with uterus must also take a progestin. Is estrogen contraindicated occasionally progestins (such as medroxyprogesterone acetate 10 mg po 1 times / day or 150 mg Depot i.m. 1 times / month, megestrol acetate 10-20 mg 1 time / day po.) Given alone against hot flashes; but they are less effective than estrogen to treat hot flashes and do not reduce the vaginal dryness. Micronized progesterone can be taken at doses of 100-200 mg at bedtime. Drowsiness may occur. In women with a peanut allergy micronized progesterone is contraindicated. Estrogen therapy has a positive on bone density and reduces the incidence of fractures in postmenopausal women (but only slightly in women with osteoporosis). Nevertheless, estrogen is not recommended (with or without progestin) as first-line treatment or prevention of osteoporosis. Applies only osteoporosis medical attention, only women should receive hormone therapy, which have a significantly increased risk of osteoporosis and can not take drugs of first choice for osteoporosis (osteoporosis: Therapy) .Risiken and side effects Possible risks of estrogen – and a combined estrogen – progestin therapy are endometrial cancer, especially in women with uterine taking estrogen without progestin deep vein thrombosis pulmonary embolism stroke breast cancer gallbladder disease stress incontinence the risk of breast cancer increases 3-5 years after the start of the combination therapy. Is estrogen given alone, the risk of breast cancer only 10-15 years may increase after initiation of therapy. The incidence of gallbladder disease and urinary incontinence may be increased. Healthy women, hormone therapy only temporarily, during or shortly after received the perimenopause, have a low risk for these diseases. Older postmenopausal women (> 10 years after menopause) are at greater risk for the majority of these diseases and may be at increased risk of Koronargefäßerkrankung in combination therapy have. By using transdermal estrogen, the risk of VTE may be reduced. In women who had an increased risk of breast cancer, stroke, or thrombosis or Koronargefäßerkrankung have estrogen therapy may be contraindicated. Progestins may have undesirable side effects (eg. As bloating in the abdomen, tenderness of breasts, increased density of the breast tissue, headache, increase in LDL, decrease in HDL levels). Micronized progesterone appears to have fewer unwanted side effects. Progestins increase the risk of thrombosis. Long-term safety data for progestins are not available. Before prescribing hormone therapy risks and advantages discussed with the women werden.Selektive estrogen receptor modulators should (SERM) The SERMs tamoxifen and raloxifene were primarily due to their anti-estrogenic properties and not used to treat menopausal symptoms. However ospemifene can (60 mg po 1 time / day), a SERM, be given for the treatment of dyspareunia due to vaginal atrophy, when estrogen or a vaginal preparation (z. B. due to severe arthritis) can not be used or if a oral, non-estrogen-containing preparation is preferred. Bazedoxifene in combination with conjugated estrogens can reduce hot flushes and vaginal atrophy. Venous thromboembolism is comparable to protect with estrogen, but the drug appears to the endometrium and possibly the breast. Bazedoxifene is not yet available in the United States as a single agent. Summary The average age for the onset of menopause in the US is at 52 years. The menopausal symptoms are usually in the years before and a year after menopause (during perimenopause) most, except with servers of symptomatic vulvovaginal atrophy, which can be worse over time. Menopause can be considered confirmed when a corresponding age and no pregnancy, and no menses for 12 months available. Against vaginal dryness and vaginal stimulation freierhältliche vaginal lubricants and moisturizers are recommended; they are ineffective, low-dose, vaginally administered, estrogen-containing creams, tablets or rings are prescribed. the women have about the potential risks (eg deep vein thrombosis, pulmonary embolism, stroke, breast cancer; low risk of gallbladder disease and stress urinary incontinence.) before the start of hormone therapy be elucidated. When women choose hormone therapy to treat hot flashes, estrogen should and are also prescribed for women with uterine progestogen. SSRIs, SNRIs and gabapentin may be considered as less effective alternatives to hormone therapy for hot flashes into consideration.