A15. Menopause

Definition

Menopause is the cessation of menses. It’s characterised by symptoms caused by the decline and loss of ovarian function. The official date of the menopause is the last menstruation which is then followed by amenorrhoea in the next 6 – 12 months. Menopause occurs at approximately 45 – 55 years.

Menopause is one event in the climacteric period, sometimes called perimenopause or the menopausal transition. The climacteric is the period of life starting from the decline of ovarian function until after the end of ovarian function. It begins when the woman starts to experience increasingly infrequent menstruation, usually in the 40s.

However, the terms menopause and climacteric are sometimes used interchangeably, and the term menopause is sometimes used to mean the whole climacteric period.

Hormonal changes

As the number of ovarian follicles in the ovaries decreases with age, so does the ovarian function. Eventually, the ovarian function decreases so much that oestrogen deficiency becomes symptomatic. Due to decreased negative feedback on the hypothalamus and pituitary, FSH and LH levels increase. At and after menopause, oestrogen and progesterone production are at a minimum.

Oestrogen-dependent tissues atrophies, including the uterus, endometrium, vaginal epithelium, and glandular tissue of the breast.

Clinical features

Many symptoms may occur during the climacteric, all of which are related to oestrogen deficiency. The symptoms may begin up to 6 years before menopause and continue for a number of years afterward.

Acute symptoms include:

  • Vasomotor symptoms
    • Hot flushes – vasodilation of the face, neck, and upper chest with sweating
      • Ends 2 – 5 years after menopause
    • Night sweats
    • Headache
  • Psychological symptoms
    • Insomnia
    • Anxiety
    • Irritability
    • Memory loss
    • Poor concentration
    • Mood changes

Lasting symptoms include:

  • Vaginal atrophy
  • Dyspareunia
  • Loss of libido
  • Urethral syndrome
  • Skin thinning
  • Loss of hair

Late consequences include:

  • Osteoporosis
  • Cardiovascular disease
  • Cerebrovascular disease
  • Depression
  • Alzheimer

Treatment

See topic B16


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