Variable time beginning a few years before and continuing after the event of menopause
PERIMENOPAUSE
Menopausal transition
o Irregular bleeding
o Hot flushes
o Inability to conceive
Time after the cessation of reproductive functions
CLIMACTERIC
Hypergonadotropic ovarian failure occurring prior to age 40
PREMATURE OVARIAN FAILURE
permutation in ______ syndrome
fragile X syndrome
MENOPAUSE
Management:
o Estrogen replacement
Cessation of menstruation > 1 yr
– earliest sign
Menstrual alterations
diminish significantly 1 yr after menopause
Estradiol
Rise in _____ before the decrease of the estradiol and it will become stable about 2 yrs after the menopause
FSH
– prevents vasomotor symptoms
ESTROGEN
TREATMENT OF ESTROGEN DEFICIENCY
Prevent osteoporosis
SERMs (selective estrogen receptor modulators)
Tibolone
Bisphosphonates
ALTERNATIVE THERAPIES
Antidepressant (SSRIs-selective serotonin reuptake inhibitors)
Gabapentin
Antihypertensives
Phytoestrogens
Cognitive behavior therapy
Stellate ganglion blockade
o Monthly ability to get pregnant/conceive
Fecundability
o Inability of a couple to conceive after 1 year of trying
Infertility
For Etiology and Evaluation of infertility table
– anatomic abnormalities
Ultrasound
o Direct visualization of the uterine cavity and fallopian tube lining
o 1 wk after menstruation
Hysterosalpingography
o At least 5 motile sperm is visible prior ovulation
Post coital test (not routine)
o Direct visualization of the peritoneal cavity
• Laparoscopy
infertility: TREATMENT
o Ovulatory drug: First line
Clomiphene citrate
TREATMENT
o Competes with endogenous circulating estrogen in the hypothalamus; it blocks negative feedback; GnRH is released in normal manner
o Thick mucus; thin endometrium
biguanide
o Effective in PCOS
Metformin and other insulin sensitizers
– aromatase inhibitors
o Inhibits E2 production during the 5 days of administration; increases FSH
o Short acting - Thick mucus; thin endometrium (not observed)
o Given if not responsive to clomiphene citrate
Letrozole
o Estrogen level is low and non-responsive to CC and Letrozole
Gonadotropins
primary
Weight and lifestyle management:
UTERINE CAUSES OF INFERTILITY
Intrauterine adhesions
Leiomyoma
Tuberculosis
Tubal causes of infertility
o Distal and proximal
Endometriosis
• Couples with normal ovulation and pelvic evaluation with a normal uterus and patent tubes on HSG as well as normal semen analysis.
UNEXPLAINED INFERTILITY
IVF/IVF-ICSI
• ART(assisted reproductive technologies)
• In vitro fertilization
• Intracytoplasmic sperm injection
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