Menopause

Menopause refers to the natural halting of the menstrual cycle due to depletion of ovarian follicles.

– It is defined as amenorrhoea for 2 years below the age of 50 or 12 months over the age of 50.

– The average age of menopause in the UK is 51.

– Perimenopause refers to the period before the menopause in which the woman begins to experience symptoms of the approaching menopause 

Symptoms:

– Menstrual changes -> change in length, frequency and amount of blood loss

– Hot flushes and night sweats

– Joint and muscle aches

– Atrophic vaginitis -> vaginal dryness/discomfort, superficial dyspareunia, recurrent UTIs

– Mood changes

– Sleep problems

Complications:

– Osteoporosis –> as oestrogen protects bone mass by reducing osteoclast activity

– Increased risk of ischaemic heart disease –> as oestrogen is protective against IHD iii) Increased risk of dementia

Diagnosis:

– Perimenopause –> diagnose if the woman has irregular periods and hot flushes/night sweats

– Menopause –> diagnosis when periods have been absent for at least 12 months

– Can measure FSH levels (tend to be high), which gives you estimate of ovarian reserve

Management (according to NICE Guidelines1):

i) Conservative:

– Exercise, weight loss, sleep and stress reduction

ii) Hormone replacement therapy:

– If vaginal symptoms only –> prescribe oestrogen topical gel

– If no uterus or IUS (coil) –> can prescribe oestrogen only HRT

– If they have a uterus –> combined oestrogen and progesterone HRT

–> if perimenopausal (last period <1 year ago) –> cyclical regime

–> if postmenopausal (last period >1 year ago) –> continuous

iii) Other medical management: (if HRT declined/contrindicated)

– For Vasomotor symptoms –> fluoxetine, citalopram or venlafaxine

– For Vaginal dryness –> lubricant or moisturiser

– For Mood disturbance –> self-help groups, CBT, antidepressants

Premature Ovarian Failure