Menopause


  • Menopause is an event - the cessation of menstruation and is usually diagnosed 12 months in retrospect

  • Climacteric is the period from onset of symptoms to the menopause

  • Occurs at approximately 45-55 years

Physiology

  • Oocyte depletion

  • Increasing ovarian insensitivity

  • falling oestrogen

  • Increased FSH to maintain oestrogen production and then falling oestrogen levels

  • Continuing production of androstenedione, testosterone, oestrone

Clinical Features

  • Median age 51 years, approx 95% women by 55

  • Not unusual if after 45

  • Earlier in smokers or with Down's syndrome

  • Menstrual disorders - irregular cycles

  • Short term symptoms

    • 2/3 women have vasomotor instability

      • hot flushes

      • night sweats

      • palpitations

    • urogenital

      • vaginal dryness

      • dyspareunia

      • frequency/urgency

      • breast atrophy

    • psychological

      • mood swings

      • irritability

      • depression

      • loss of libido

Long term effects

  • osteoporosis

  • weight gain

  • cadiovascular disease

  • urogenital atrophy

  • skin and collagen changes

  • miscellaneous

Premature menopause

  • occurs before 42 years in 5% women

  • Aetiology (?)

    • heredity

    • chromosomal abnormalities

    • radiation

    • viral agents

    • auto-immune disease

    • bilateral oophorectomy

    • radiotherapy

Management

  • Well woman health screen

    • BP

    • smears

    • mammogram

  • Family history

    • osteoporosis

    • CVD

    • cancers

  • Targeted investigations

    • bone densitometry

    • lipids

  • Investigation of abnormal uterine bleeding

  • Consideration of HRT

  • Follow up