Menopause
S/S	·       Vasomotor sx (hot flashes) ·       Oligomenorrhea/amenorrhea ·       Sleep disturbances ·       Decreased libido ·       Depression / Cognitive decline ·       Vaginal atrophy
Dx	Clx – ⤴️ FSH
Tx	·       Depends on severity: ·       Mild hot flashes? Lifestyle (weight loss) ·       Severe? HRT ·       Topical vaginal estrogen ·       Contraindications to HRT? Coronary heart dz / TIA/ Stroke/ breast cancer / endometrial cancer ·       If pt has contraindications? SSRI ·       For osteoporosis: o   start screening w/ DEXA @ 65 yo o   give bisphosphonate + Vit D + Ca ·       For ♡: o   Screen w/ LDL o   If ⊕ (high risk) → Statin

	Genitourinary syndrome of menopause
Sx	·       Vulvovaginal dryness, irritation, pruritus ·       Dyspareunia ·       Vaginal bleeding ·       Urinary incontinence, recurrent urinary tract infection ·       Pelvic pressure
PEx	·       Narrowed introitus ·       Pale mucosa, elasticity, I rugae ·       Petechiae, fissures ·       Loss of labial volume
Tx	·       Vaginal moisturizer & lubricant ·       Topical vaginal estrogen

	Pelvic Organ Prolapse
Types	·       Cystocele – bladder ·       Rectocele – rectum ·       Enterocele – small intestine
RF	·       Obesity ·       Multiparity / Postmenopausal ·       Hysterectomy
Clx	·       Pelvic pressure ·       Obstructed voiding (resembles BPH) ·       Urinary retention / Incontinence ·       Fecal Constipation /urgency, incontinence ·       Sexual dysfunction
Tx	·       Weight loss – Pelvic floor exercises ·       Vaginal pessary ·       Surgical repair