Menopause

• Facts:
  Average age is 51 years old
• History / PE:
  Irregular/absent menses
  Heat intolerance
  Flushing
  Insomnia
  Night sweats
• Diagnosis:
  Increased FSH levels
  Check TSH levels (rule out hyperthyroidism )
  DEXA scan ( osteoporosis )
• Treatment:
  Venlafaxine (vasomotor symptoms)
  Estrogen cream/estradiol vaginal ring (vaginal atrophy)
  Calcium supplementation ( osteoporosis prevention)
  HRT should not be 1st line agent
• Notes:
  Major source of estrogen in PP women is the peripheral conversion of adrenal androgens by the aromatase enzyme present in adipose tissue/peripheral fat (this is why obese women report less menopausal symptoms)
• Differential Diagnosis:
  Hyperthyroidism