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An Update on Menopause
HP Pattanaik, PC Mahapatra
1:
Endocrinology of Menopause
INTRODUCTION
THE ENDOCRINOLOGY OF LATE REPRODUCTIVE AGING
THE ENDOCRINOLOGY OF MENOPAUSE TRANSITION
BRIEF REMARKS ON INDIVIDUAL COMPONENTS OF THE ENDOCRINE LOOP (HPO AXIS)
Changes in Ovarian Regulatory Proteins—Inhibins, Activins and Follistatin
Changes in FSH Feedback Control and Levels
Changes in LH Feedback Control and Levels
Changes in Estradiol Feedback and Levels
Changes in Ovulation and Progesterone Levels
Beyond the HPO axis-Role of higher centers and neuropeptides on menopausal transition
CONSEQUENCES OF THE CHANGES IN REPRODUCTIVE HORMONAL SECRETION
CLINICAL CORELATION OF MENOPAUSAL ENDOCRINOLOGY
SUMMARY
2:
Spectrum of Menopausal Problem
HOW COMMON ARE THE VARIOUS MENOPAUSAL SYMPTOMS4,5
MENOPAUSE: COMMON PROBLEMS6–8
Irregular Menstrual Cycles
Body Temperature: Hot Flashes, Hot Flushes
Mood Swings
Vaginal Discomfort
Other Menopausal Symptoms
Weight Gain
Breast Changes
Itchy Skin
Memory Loss
Vision Problem
MAJOR HEALTH CONCERNS AFTER MENOPAUSE9
Bone Loss
Heart Disease
Cerebrovascular Changes
3:
Menopause and Urogenital Problems
INTRODUCTION
ANATOMICAL AND PHYSIOLOGICAL ASPECTS OF GENITOURINARY SYSTEM
CHANGES DURING MENOPAUSE
MENOPAUSAL PROBLEMS RELATED TO URINARY SYSTEM
Urinary Tract Infection
Management
Urinary Incontinence
Management of SUI
Menopausal Problems Related to Genital Tract
History and Clinical Examination:
Investigations:
INDIVIDUAL PROBLEMS
Pruritus Vulvae
Reproductive Tract Infections
Uterovaginal Prolapse
Etiological Factors
Postmenopausal Bleeding
Vulvo-Vaginal Disorders (Benign/Malignant)
Gynecological Malignancies
Gynecological Emergencies
Psychosexual Problems
CONCLUSION
4:
Postmenopausal Bleeding
DEFINITION
INCIDENCE
ETIOLOGY
DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
INVESTIGATIONS
SONOGRAPHY
MRI
Endometrial Sampling
Hysteroscopy
PREVENTION
TREATMENT
5:
Psychosocial Problems Round Menopause
INTRODUCTION
SEXUAL CHANGES IN MIDLIFE
IMPACT OF SOCIAL FACTORS ON SEX LIFE
MEDICAL FACTORS WHICH AFFECT SEXUAL ACTIVITY
EFFECT OF MEDICATION ON SEXUAL ACTIVITY
TREATMENT OF PSYCHOSOCIAL PROBLEMS
SUPPORTIVE TREATMENT
MEDICATION AND SURGERY
6:
Estrogen and Bone
BONE STRUCTURE AND COMPOSITION
BONE REMODELING
OSTEOPOROSIS
ESTROGEN AND BONE TURN-OVER
POSTMENOPAUSAL OSTEOPOROSIS
LESSONS LEARNED FROM THE WOMEN'S HEALTH INITIATIVE STUDY
NON-PHARMACOLOGICAL THERAPY
CALCIUM/VITAMIN D
EXERCISE
DRUG THERAPY
BISPHOSPHONATES
SELECTIVE ESTROGEN RECEPTOR MODULATORS
ESTROGEN/PROGESTIN THERAPY
CALCITONIN
ISOFLAVONES
7:
Hormone Replacement Therapy (Conventional)
CONCLUSION
8:
Selective Estrogen Receptor Modulators (SERMs)
INTRODUCTION
WHAT ARE SERM
MECHANISM OF ACTION
SERMs AND HRT
Raloxifene
Effects on Fracture Rates
Cardiovascular Effects
Uterine Effects
Neuroprotective Effect
Ovarian Cancer
Pelvic Floor Disorders
SERMs and Bladder Control
Contraindications
Dose
Side Effects
Other Important Effects
SUMMARY
Tamoxifen
Endometrial Cancer
Ovarian Cancer
Side Effects
Other SERMs
Future of SERMs in terms of perimenopause and menopause?
CONCLUSION
9:
Tibolone: The First Stear (How much do we know?)
10:
Role of Phytoestrogens in the Management of Menopause
11:
Non-hormonal Therapy for Menopause
COUNSELING OF THE WOMAN AND HER PARTNER
ALTERNATIVE TREATMENT FOR VARIOUS MENOPAUSAL SYMPTOMS
KEGEL'S TYPE PELVIC FLOOR EXERCISE
SCIENCE OF LIVING
Diet Appropriate to Menopausal Age
The Basis
The Advice—Take
Take Special Estrogenic Diet
Exercise
Yoga
Attain Ideal Body Weight
Arrange to Avoid Fall
Avoid Addiction
Do a Good Deed Every Day
CONCLUSION
12:
Consensus and Controversies in Hormone Replacement Therapy (HRT)
INTRODUCTION
CONSENSUS REGARDING HRT USE
Regarding Effectiveness for Symptom Relief—Vasomotor, Vaginal, Urinary
Osteoprotection
Decrease in Colorectal Cancer
Premature Menopause
CONSENSUS REGARDING PROBLEMS WITH HRT
Increased Risk of Breast Cancer Detection
Increased Risk of Thromboembolism
CONTROVERSIAL BENEFITS OF HRT
Cognitive Function
Schizophrenia
Depression
Quality of Life
CONTROVERSIAL PROBLEMS WITH HRT
Primary Cardio-protection
CONSENSUS ON PRE-HRT INVESTIGATIONS
CONSENSUS ON FOLLOW-UP REGIMEN
CONTROVERSY ON DURATION OF HRT USE
SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMS)
TESTOSTERONE
13:
PCOS and Menopause
SUMMARY AND CONCLUSION
14:
Premature Ovarian Failure
INTRODUCTION
Prevalence of Premature Ovarian Failure
Etiopathology of Premature Ovarian Failure
Spontaneous Premature Ovarian Failure
Induced (Iatrogenic) Ovarian Failure
Important Causes of Premature Ovarian Failure
Clinical Features of Premature Ovarian Failure
Diagnosis of Premature Ovarian Failure
Tests for Establishing the Diagnosis of Premature Ovarian Failure
Investigations to Clarify the Etiology of Ovarian Failure
Management of Premature Ovarian Failure
Counseling
Referrals to Other Specialists
Restoration of Fertility
Replacement of Deficient Ovarian Hormones
Prognosis
15:
Ovaries at Hysterectomy
INTRODUCTION
OOPHORECTOMY'FACTS AND FICTIONS
At What Age Does This Ovary Cease to Function?
Do Preserved Ovaries Continue to Function Normally After Hysterectomy?
Can Operative Technique Affect Ovarian Function?
Are There Significant Health Hazards When Normal Ovaries are Removed from Premenopausal Women?
Are There significant Health Hazards When Ovaries are Preserved in Premenopausal Women?
How Rational is Age for Oophorectomy?
How Effective is Hormone Replacement?
CONCLUSION
16:
Art of Living and Menopause
INTRODUCTION
A Positive Attitude
Lack of Creativity
Narrowing Generation gap
Enjoying the Increased Libido
Letting the Young Ones Fly Free
Improving Physical Strength with Exercise
17:
Androgens in Menopause
INTRODUCTION
EFFECT OF ANDROGENS ON LIBIDO
EFFECT ON VASOMOTOR SYMPTOMS
EFFECT OF ANDROGENS ON MOOD AND SENSE OF WELL BEING
EFFECT OF ANDROGENS ON BONE DENSITY
EFFECT OF ANDROGENS ON CARDIOVASCULAR CHANGES
ADMINISTRATION AND SIDE EFFECTS OF ANDROGEN REPLACEMENT
ANDROGENS AND ESTROGENS
Oral Dosages
CONCLUSION
18:
Medical Disorders and Menopause
CARDIOVASCULAR EVENTS
THE NURSE'S HEALTH STUDY QUOTES1
19:
Malignancies in Menopause
INTRODUCTION
MALIGNANCIES IN MENOPAUSE: AN OVERVIEW
VULVAR CANCER
VAGINAL CANCER
BREAST CANCER
MANAGEMENT
Endometrial Cancer
Ovarian Cancer
Vulvar Cancer
VAGINAL CARCINOMA
BREAST CANCER
20:
Role of ART in Menopausal Women
AGE AND DECLINE IN FERTILITY
ARGUMENTS AGAINST ASSISTED REPRODUCTION IN MENOPAUSAL WOMEN
ARGUMENTS IN FAVOR OF ASSISTED REPRODUCTION IN MENOPAUSAL WOMEN
SELECTION OF POSTMENOPAUSAL WOMEN FOR ART
OOCYTE DONOR RECRUITMENT
OOCYTE DONOR SCREENING
ENDOMETRIAL STIMULATION AND SYNCHRONIZATION
EMBRYO DONATION
CONSENT
PREGNANCY COMPLICATIONS IN OLDER WOMEN
21:
Pelvic Floor Relaxation in Menopause
INTRODUCTION
ANATOMY OF THE PELVIC FLOOR
CONDITIONS RESULTING FROM PELVIC FLOOR RELAXATION
Urinary Problems
Stress Urinary Incontinence (SUI)
Other Urological Symptoms
Urinary Infection
Genital Tract Problems
Genital Prolapse
Sexual Dysfunction
Anorectal Dysfunction
CONCLUSION AND KEY POINTS
INDEX
TOC
Index
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