28 Aug Menopause

• Definition:
  • Traditionally known as the “climacteric”: the time in an adult woman’s life when she ceases to become fertile and has no menstrual periods.
  • Medically speaking: A woman has had no periods for 12 consecutive months.
  • Not a disease state: natural process that all women go through.
• Cause:
  • Sudden decrease in the estradiol and progesterone levels by the ovaries, which fail to release eggs or to have a corpus luteum.
• Average age: 51 years; can happen as early as 40 years or as late as 60 years and considered normal.
• Premature ovarian failure:
  • Menopause occurs prior to age 40.
  • Incidence: about 1-2 percent.
  • Confirmed: consistently elevated three separate FSH and LH levels four weeks apart in the presence of amenorrhea before the age of 40 years.
  • Causes of premature ovarian failure:
    • A carrier of fragile X syndrome,
    • Radiotherapy for the pelvis,
    • Chemotherapy for cancer early in life,
    • Autoimmune disorder,
    • Diabetes,
  • Women with gynecological disorders like PCOS and endometriosis: greater risk of premature ovarian failure.
• Surgical menopause: The uterus and ovaries removed surgically for various reasons.
  • Symptoms: severe, with frequent hot flashes and other menopausal symptoms.
• Menopausal symptoms:
  • Spotting after intercourse and pain during intercourse is caused by vaginal dryness,
  • Atrophy of the vagina stems from a lack of estrogen,
  • Atrophic vaginitis: inflammation of the vaginal tissues brought on by a lack of circulating estrogen.
  • Less common symptoms:
    • Fatigue,
    • Arthralgias,
    • Muscle stiffness,
    • Low back pain,
    • Breast tenderness,
    • Palpitations of the heart,
    • Headaches,
    • Weight changes,
    • Urinary incontinence,
    • Insomnia,
    • Night sweats, and
    • Psychological effects,
      • Increased anxiety,
      • Poor concentration,
      • Poor memory,
      • Irritability,
      • Decreased libido,
      • Depressed affect, and
      • Mood swings.
    • Perimenopausal Symptoms:
      • Irregular periods: shorter or longer in duration with variable amounts of blood flow.
      • Hot flashes happen before menopause: feeling of being hot or flushed repetitively: occur throughout the day: last only about 30-60 seconds at a time.
      • Night sweats,
      • Insomnia,
      • Mood changes,
      • Urinary tract changes, and
      • Vaginal dryness.
    • Post menopause:
      • Periods have stopped completely for a minimum of twelve consecutive months.
      • Persistent elevations of the FSH.
      • Several additional years for the menopausal symptoms to completely disappear.
    • Treatment of menopause:
      • It doesn’t have to be treated if the symptoms are tolerable.
      • Estrogen replacement therapy: mainstay of menopausal and perimenopausal management.
      • Steady doses of estrogen: reduce or eliminate the hot flashes.
      • Progesterone, in addition to estrogen, may be given to women with uterus to avoid proliferation of the endometrial lining:
        • Reduces the rate of vaginal bleeding,
        • Reduces the risk of endometrial lining atypia and endometrial cancer.
      • Advantage and disadvantage of using estrogen replacement therapy
        • Reduces bone mass loss: osteoporosis
        • May increase the risk of heart disease or thromboembolic disease.
      • Adding testosterone in small quantities to the estrogen
        • Positive impact on sexual functioning with an improvement in libido and an increase in orgasmic potential.
        • May increase androgen-related symptoms, such as acne, facial hair growth, and a decrease in HDL cholesterol.
      • Other medications to treat menopausal symptoms:
        • SSRIs (selective serotonin reuptake inhibitors).
        • SNRIs (serotonin and norepinephrine reuptake inhibitors).
        • • improve the psychological symptoms seen in menopause,
          • reduce the frequency of hot flashes and night sweats.