Epidemiology
Etiology
Pathophysiology
- Core Pathophysiology: Progressive depletion of ovarian follicles. This results in a decline in the production of inhibin B and estrogen.
- Remaining follicles become resistant to FSH.
- Key Hormonal Changes:
- 1st: ↓ Inhibin B → loss of negative feedback → ↑ FSH (most sensitive marker).
- 2nd: Follicular failure → ↓↓ Estrogen.
- Result: Markedly ↑ FSH, ↑ LH, ↓ Estrogen.
- Consequences of Estrogen Deficiency:
- Vasomotor: Hot flashes (hypothalamic thermoregulatory dysfunction, likely due to estrogen withdrawal).
- GU Syndrome: Vaginal/urogenital atrophy → dryness, dyspareunia, ↑ UTIs.
- Bone: ↑ Osteoclast activity → Osteoporosis.
- Cardiovascular: ↑ LDL, ↓ HDL → ↑ CAD risk.
- Other: Insomnia, mood changes, skin thinning.
Clinical features
- Vasomotor symptoms: Hot flashes, night sweats.
- Genitourinary Syndrome of Menopause (GSM):
- Vaginal atrophy: Dryness, itching, dyspareunia (painful intercourse).
- Urologic issues: Dysuria, urinary urgency, increased frequency of urinary tract infections.
- Psychological symptoms: Mood swings, insomnia, depression, anxiety, and memory changes (“brain fog”).
- Dermatologic symptoms: Skin thinning and hair loss.
Diagnostics
Supportive studies to confirm menopause
- FSH: ↑↑; however, levels widely fluctuate during perimenopause
- Estradiol: ↓
- Rarely tested for as not routinely recommended: ↓ progesterone, ↓ inhibin B, and ↓ antimüllerian hormone
Studies to exclude differential diagnoses of menopause
Treatment