1.
How to manage Menopause
TEVFİK YOLDEMİR MD. BSc. MA. PhD.
tevfikyoldemir
yoldemirtevfik

2.
THE SYMPTOMS OF THE MENOPAUSE
1. Vasomotor symptoms (VMS)
– hot flushes
– night sweats
2. Psychological
– depressive symptoms
– anxiety/irritability
– sleep disturbance
– overall diminished well-being
– lessened memory
– lessened concentration
3. General physical
– sleep disturbance
– fatigue
– headaches
– muscle/joint pains
– crawling sensations on skin (formication)
4. Urogenital and sexual
– vaginal itching, burning
– dryness and dyspareunia
– urinary frequency, urgency.
Late reproductive phase
• Changes in menstrual cycle flow/length;
• FSH, E2 variable;
• AMH, inhibin B low;
• Some women develop intermittent symptoms.
Menopause transition (perimenopause)
• Increased cycle variability;
• FSH increased;
• E2 variable;
• AMH, inhibin B low;
• Symptoms more likely
Postmenopause
• Cessation of menstruation;
• FSH elevated;
• E2, AMH, inhibin B low, progesterone continually low;
• Symptoms much more likely.
Climacteric, 2014;17:5, 564-579, DOI: 10.3109/13697137.2014.929651

3.
Algorithm and mobile app for menopausal symptom
management

4.
Primary care management of menopause
Can Fam Physician 2017;63:295-8

5.
Can Fam Physician 2017;63:295-8

6.
Can Fam Physician 2017;63:295-8

7.
Climacteric, 2014;17:5, 564-579, DOI: 10.3109/13697137.2014.929651

8.
Climacteric, 2014;17:5, 564-579, DOI: 10.3109/13697137.2014.929651

9.
Climacteric, 2014;17:5, 564-579, DOI: 10.3109/13697137.2014.929651

10.
Climacteric, 2014;17:5, 564-579, DOI: 10.3109/13697137.2014.929651

11.
Climacteric, 2014;17:5, 564-579, DOI: 10.3109/13697137.2014.929651

12.
Climacteric, 2014;17:5, 564-579, DOI: 10.3109/13697137.2014.929651

13.
Climacteric, 2014;17:5, 564-579, DOI: 10.3109/13697137.2014.929651

14.
Climacteric, 2014;17:5, 564-579, DOI: 10.3109/13697137.2014.929651

15.
Climacteric, 2014;17:5, 564-579, DOI: 10.3109/13697137.2014.929651

16.
Climacteric, 2014;17:5, 564-579, DOI: 10.3109/13697137.2014.929651

17.
Climacteric, 2014;17:5, 564-579, DOI: 10.3109/13697137.2014.929651

18.
Climacteric, 2014;17:5, 564-579, DOI: 10.3109/13697137.2014.929651

19.
The Journal of Clinical Endocrinology & Metabolism, 2021, Vol. 106, No. 1, 1–15

20.
The Journal of Clinical Endocrinology & Metabolism, 2021, Vol. 106, No. 1, 1–15

21.
The Journal of Clinical Endocrinology & Metabolism, 2021, Vol. 106, No. 1, 1–15

22.
CLINICAL OBSTETRICS AND GYNECOLOGY
Volume 62, Number 4, 677–686

23.
CLINICAL OBSTETRICS AND GYNECOLOGY
Volume 62, Number 4, 677–686

24.
Climacteric, 2016;19:5, 426-429, DOI: 10.1080/13697137.2016.1222483

25.
Climacteric, 2016;19:5, 426-429, DOI: 10.1080/13697137.2016.1222483

26.
Climacteric, 2016;19:5, 426-429, DOI: 10.1080/13697137.2016.1222483

27.
NICE guideline
Published: 12 November 2015
www.nice.org.uk/guidance/ng23

28.
NICE guideline
Published: 12 November 2015
www.nice.org.uk/guidance/ng23

29.
Kardiyovasküler Sağlık,
Metabolik Sendrom ve DM

30.
Diabetes Care Volume 39, Supplement 1, January 2016

31.
Diabetes Care Volume 39, Supplement 1, January 2016

32.
NIH Publication No. 01-3670, May 2001

33.
NIH Publication No. 01-3670, May 2001

34.
NIH Publication No. 01-3670, May 2001

35.
NIH Publication No. 01-3670, May 2001

36.
NIH Publication No. 01-3670, May 2001

37.
NIH Publication No. 01-3670, May 2001

38.
Systematic COronary Risk Evaluation
European Heart Journal (2003) 24, 987–1003

39.
SCORE2
European Heart Journal (2021) 42, 2439–2454
45 cohorts in 13 countries (677 684 individuals, 30 121 CVD events)

40.
European Heart Journal (2021) 42, 2439–2454

41.
European Heart Journal (2021) 42, 2439–2454

42.
European Heart Journal (2021) 42, 2439–2454

43.
European Heart Journal (2021) 42, 2439–2454

44.
Am J Cardiol 2006;98[suppl]:2H–15H
coronary artery calcium (CAC) score
carotid intima-media thickness test

45.
Am J Cardiol 2009;103:1174 –1177

46.
Am J Cardiol 2009;103:1174 –1177

47.
Circulation. 2019;140:e596–e646. DOI: 10.1161/CIR.0000000000000678

48.
Circulation. 2019;140:e596–e646. DOI: 10.1161/CIR.0000000000000678

49.
Circulation. 2019;140:e596–e646. DOI: 10.1161/CIR.0000000000000678

50.
2019 ACC/AHA Guidelines for Primary Prevention of
Cardiovascular Disease
Circulation. 2019;140:e596–e646. DOI: 10.1161/CIR.0000000000000678

51.
validated multivariable risk scores available
1) The current Framingham risk score for prediction of 10-year risk for all CHD events (incident angina pectoris,
coronary insufficiency, myocardial infarction, and CHD death);
2) The ATP III Risk Assessment Tool (online at http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=prof) for
prediction of 10-year risk for hard CHD events (incident nonfatal myocardial infarction or CHD death);
3) The European HeartScore Programme (online at http://www.heartscore.org) for prediction of 10-year risk for all
fatal atherosclerotic CVD events.
4) Reynolds Risk Score for CVD risk estimation in women
It is unclear at present whether 1 risk score should be favored over another. Practitioners may wish to use a risk
score that has been derived or validated in a population similar to their patient population or one that is tailored
to the outcomes for which an individual patient may be at risk.
Circulation. 2009;120:1296-1336

52.
Framingham
risk
score
Circulation. 2009;120:1296-1336

53.
Breast Cancer risk assesment tools
https://breastcancerrisk.canceraustralia.gov.au/
https://www.cancer.gov/bcrisktool/
https://tools.bcsc-scc.org/BC5yearRisk/calculator.htm
http://www.ems-trials.org/riskevaluator/

54.
Adnexial mass malignancy risk scoring
• http://www.iotagroup.org/adnexmodel/site%20iota.html
• http://www.hutchon.net/rmicalc.htm
• https://xema-medica.com/eng/sets/calc/

55.
Fracture risk assesment
• https://www.sheffield.ac.uk/FRAX/tool.aspx?country=9
• https://riskcalculator.fore.org/
• https://qfracture.org/

56.
CVD Risk assesment tools
• http://www.cvriskcalculator.com/
• http://tools.acc.org/ASCVD-Risk-Estimator-
Plus/#!/calculate/estimate/
• https://www.mdcalc.com/framingham-coronary-heart-
disease-risk-score

57.
TEVFİK YOLDEMİR MD. BSc. MA. PhD.
tevfikyoldemir
yoldemirtevfik