SILLIMAN UNIVERSITY MEDICAL SCHOOL

SUBMITTED TO: DR. DAPHNE LYNN R. RANA

SUBMITTED BY:

DELA CRUZ, CELINE VENERIA F. DEPOSA, LYRA ALTHEA M.

CORSINO, JOVILYN A.

I. REPRESENTATIVE CASE

REVIEW OF SYSTEMS PHYSICAL EXAMINATION

II. PRIMARY WORKING IMPRESSION

DIAGNOSIS RULE IN

APPROACH TO THE PATIENT

III. DIFFERENTIAL DIAGNOSIS

DIAGNOSES RULE IN RULE OUT

IV. RATIONAL LABORATORY & DIAGNOSTIC TESTS

FINAL DIAGNOSIS
MENOPAUSAL TRANSITION

Menopausal transition begins with menstrual cycle irregularity and extends to 1 year after permanent cessation of menses. This
reproductive aging with loss of follicular activity progresses within a wide age range (42 to 58 years). The average age at its onset is 47,
and MT typically spans 4 to 7 years. It begins with variability in menstrual cycle length accompanied by rising FSH levels and ends
with the final menstrual period. During this period, LH and FSH levels gradually rise because of diminished estrogen production. The
more erratic fluctuations in female reproductive hormones lead to an array of physical and psychological symptoms such as hot flashes,
mood changes, insomnia, depression, osteoporosis, and vaginal atrophy.

There are long term consequences of decreased estrogen production during the menopausal transition. From a cardiovascular
standpoint, the protective benefits of estrogen on the lipid profile (increased high-density lipoprotein [HDL] and decreased low-density
lipoprotein [LDL]) and on the vascular endothelium (prevents atherogenesis, increases vasodilatation, and inhibits platelet adherence)
are lost. Thus, women are at increased risk for coronary artery disease. With menopause, bone resorption accelerates because estrogen
plays an important role in regulating osteoclast activity. The increased bone resorption can lead to osteopenia and potentially
osteoporosis, particularly in thin (weight <127 lbs.), Caucasian and Asian background, and those with a family history of osteoporosis.
Subsequently, menopausal patients are at risk of hip and vertebral fractures, pain, loss of height, and immobility.
V. PATHOPHYSIOLOGY

As women grow older, the ovarian follicles diminish in number. There is a decline in granulosa cells of the ovary,
which were the main producers of estradiol and inhibin. With the lack of inhibition from estrogen and inhibin on
gonadotropins, follicle-stimulating hormone, (FSH) and luteinizing hormone (LH) production increases. FSH levels are
usually higher than LH levels because LH is cleared from blood faster. The decline in estrogen levels disrupts the
hypothalamic pituitary ovarian axis. As a result, a failure of endometrial development occurs causing irregular menstrual
cycles, until they stop altogether.
VI. THERAPEUTIC MANAGEMENT
ADVICE AND INFORMATION PATIENT EDUCATION
1. 1.