Mohammed Abdalla
Egypt, Domiat general hospital
• is the permanent cessation of
menstruation resulting from loss of
ovarian follicular activity.
• It can only be determined after 12
months' spontaneous amenorrhoea.
• Mean age is 51 years.
• is the period of time in which the ovaries
are beginning to fail, where endocrine,
biological, and clinical changes are seen.
It ends with the final menstrual period.
• Length of the transition is approximately
4 years
is the time period over which the ovaries
are failing (when symptoms begin) up
until the cessation of menstruation, and
ends 12 months after the final
menstrual period.
is the time after the menopause, that is, after the
permanent cessation of menstruation. It can only
be determined after 12 months of spontaneous
amenorrhoea.
In practice this definition is difficult to apply,
especially in women who have started hormone
replacement therapy (HRT) in the perimenopause.
It has been estimated that by the age of 54 years,
80% of women are postmenopausal [McKinlay et
al, 1992; DTB, 1996].
occurs after bilateral oophorectomy with or
without hysterectomy.
Premature menopause may also be
radiation- or chemotherapy-induced, or
occur after hysterectomy with ovarian
conservation.
• A premature menopause is one that
occurs before the age of 40 years.
• Primary premature menopause may
occur at any age and present as
amenorrhoea. Not all women have acute
symptoms. FSH levels are elevated.
Spontaneous fertility may recur.
It is possible to discontinue the HRT or COC pill and
measure the follicle-stimulating hormone (FSH) level
after 6-8 weeks. The POP does not affect FSH levels
and so does not need to be stopped for FSH testing
[Gebbie, 1998].
An FSH value over 30 IU/L is in the postmenopausal
range, but should be repeated 4-8 weeks later to
confirm this.
Even if the FSH levels are in the postmenopausal
range, this may not reliably indicate infertility, and
contraception should be continued for a further 1 year
if the woman is over 50 years old, or a further 2 years
if she is under 50 years old .
Benign conditions is most
frequent causes of PMB but
endometrial cancer is the
most serious potential
underlying cause
75% of women with
endometrial cancer
are postmenopausal.
Risk factors for endometrial cancer
In women with continued bleeding after a negative initial evaluation, further testing
,with hysteroscopically directed biopsy is essential
Vaginal ultrasonography.
Hydrosonography.
Endometrial biopsy.
Office biopsy.
D/C biopsy.
Hysteroscopic guided biopsy.
Sensitivity and specificity are
often used to summarise the
performance of a diagnostic
test. Sensitivity is the probability
of testing positive if the disease
is truly present. Specificity is the
probability of testing negative if
the disease is truly absent.
Transvaginal ultrasound has a good correlation
with pathologic endometrial findings. Using an
endometrial thickness from myometrium to
myometrium of 5 mm (considered the upper limit
of normal) sensitivity is 91 percent and
specificity is 96 percent.
POLYP
catheter
With polyps the endometrial-myometrial POLYP
interface is preserved
The Thickened endometrium may
be a Submucosal leiomyomas
A
B