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