Definition Causes/symptoms Workup/findings Treatment
Menopause: A woman’s final menstrual A normal biological stage. Hot flushes, sleep + PE and Hx findings. Breast Ca risk assessment, HRT of
period defined retrospectively after 6-12 disturbances, urogenital atrophy, urinary Labs elevated serum FSH estrogen replacement, osteoporosis
months of amenorrhea. Avg age is 51 frequency, dysuria, dyspareunia, genital (>30mlU/ml) and LH levels, low treatment and prevention, education
bleeding, occasional stress incontinence, serum estradiol, vaginal cytology about nutrition and exercise.
amenorrhea, mild hirsutism, decrease libido positive for parabasal cells. Preventative measures discuss CHD,
Other labs to check DXA scan, stroke, breast Ca and osteoporosis.
mammography, pap smear
Premature ovarian failure: loss of ovarian Oophorectomy, radiation, chemotherapy, Exclude pregnancy, hyperthyroidism, Treat underlying cause, HRT,
function before the age of 40 autoimmune disease, chromosomal hyperprolactinemia. osteoporosis treatment and prevention,
abnormalities (Turner’s), infection, metabolic Labs elevated FSH (> 50mlU/ml); pt education about nutrition, exercise
abnormalities, trauma check TSH, calcium and and offer counseling.
phosphorous levels, estradiol 17-
beta, cosyntropin stimulation test
Differential diagnosis with symptoms consistent w/ menopause:
-Carcinoid, pheochromocytoma, mastocytosis presents w/ flushing but usually presents w/ diarrhea, hypo or hypertension, and lacks s/o hypoestrogenism.
-hyperprolactinemia lowers estrogen levels but does not present w/ vasomotor symptoms. Causes galactorhhea.
-Hypothalmic amenorrhea lacks hot flashes and has a decrease in FSH
-osteoporosis should be evaluated for primary hyperparathyroidism, hyperthyroidism and hypercortisolism
-Vulvar dermatoses or neoplasia may be mistaken for ugogenital atrophy. Biopsy!!
-Sleep disturbances, decreased sex drive, and hot flashes, assoc w/ hypoestrogenism may resemble anxiety and mood disorders.