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Menopause, symptoms, diagnosis and management

Menopause, clinical features, changes during menopause, diagnosis, management, treatment

Menopause means permanent cessation of menstruation at the end of
reproductive life due to loss of ovarian
follicular activity.
It is the point of time when last and final
menstruation occurs.
The clinical diagnosis is confirmed following stoppage of menstruation for 12 consecutive months without any other pathology.

Climacteric- It is the period of time during which a woman passes from
reproductive to non-reproductive phase.
This phase convers 5-10 years on either side of menstruation.

• Perimenopause– Part of the climacteric
when the menstrual cycle is likely to be irregular.

Post menopause- Phase of life that comes
after menopause.

  • Age of menopause- Age at which menopause occurs is genetically predetermined.
  • Age of Menopause is not related to age of menarche or age at last pregnancy.
  • Thinner women have early menopause.
    • Age of menopause ranges between 45- 55 years, average being 50 years.

Organ changes-

◾Ovaries shrink in size becoming wrinkled and white.

◾Fallopian tubes show features of atrophy.

◾Uterus becomes smaller & ratio
b/w body & cervix reverts to 1:1.
endometrium becomes thin & atrophic

◾Vagina becomes narrower due to
gradual loss of elasticity.

◾Vulva shows features of atrophy.
labia becomes flattened.

◾Breast fat is reabsorbed & glands
atrophy. Nipples decrease in size and breasts become flat & pendulous.

Bone metabolism- following menopause, there is loss of bone mass by 3-5% per year, due to deficiency of oestrogen.

Osteoporosis is a condition where there is reduction in bone mass but bone mineral to matrix ratio is normal.

◾Risk of cardiovascular disease is high in postmenstrual women due to deficiency of oestrogen.

Functions of oestrogen-

  1. Oestrogen prevents cardiovascular disease by several ways.
  2. It increases HDL and decreases LDL and total cholesterol
    1. It prevents atherosclerosis by its antioxidant property.

Menstruation pattern prior to menopause

Any of the following patterns-
i) Abrupt cessation of menstruation (rare)
ii) Gradual decrease in both amount and duration.
iii) Irregular with or without excessive
bleeding.

Menopausal symptoms

  1. Vasomotor symptoms-characteristic symptoms- ‘hot flush‘
    sudden feeling of heat followed
    by profuse sweating.
    May also have symptoms of palpitation, fatigue & weakness.
    Physiological changes – perspiration and cutaneous vasodilation. It may last for 1- 10 minutes and may at times be unbearable. Sleep may be disturbed by night sweats. Thermoregulatory centre in association with GnRH centre in hypothalamus is involved in etiology of hot flush.
  2. Genital and urinary system- oestrogen deficiency- atrophic epithelial changes in these organs. May cause dyspareunia and dysuria
  3. Vagina- Minimal trauma may cause Vaginal bleeding. Dyspareunia, vaginal infections, dryness, leucorrhoea are common.
  4. Sexual dysfunction- decreased sexual desire.
  5. Skin and hair- Thinning, loss of elasticity and wrinkling of skin. Skin collagen content thickness decreases by 1-2% per year. After menopause, some loss of pubic and axillary hair and slight balding.
  6. Physiological changes- increased frequency of anxiety, headache, insomnia, irritability, dysphagia and depression. May also suffer from dementia, mood swings, inability to concentrate.
  7. Osteoporosis and fracture- Bone loss increases 5% per year during menopause.

Diagnosis of Menopause

◾Cessation of menstruation for consecutive 12 months during climacteric. ◾Appearance of menopausal symptoms-
hot flush and night sweats. ◾Vaginal cytology – showing maturation
index of at least 10/85/5. ◾Serum estradiol <20 pg/ ml. ◾serum FSH and LH > 40 mIU/ml
(3 values at Weeks interval required)

Management

🔶 Prevention- spontaneous menopause is unavoidable.
Artificial menopause can be
prevented or delayed to some extent.
🔶 Counselling- Women with postmenopausal symptoms should be adequately explained about the physiological events.

Treatment

Non-hormonal treatment–

  • life style modification
  • Nutritious diet- with calcium and protein.
  • Supplementary calcium- 1-1.5 gm
  • Exercise
  • Vitamin D
  • Cessation of smoking and alcohol
  • Biphosphonate prevents osteoclastic bone resorption.
  • Fluoride- 1mg/kg for short term prevents osteoporosis.
  • Calcitonin inhibits bone resorption
  • Clonidine
  • Thiazides
  • Gabapentine- control hot flushes
  • Phytoestrogens- lowers incidence of osteoporosis, CVS, reduce the risk of breasts and endometrial cancer.

HRT- Hormone Replacement Therapy

Indications-

◾relief of menopausal symptoms. ◾ Prevention of oesteoporosis. ◾To maintain the quality of life in menopause.

Special group of women to whom HRT should be prescribed- 1. Premature ovarian failure. 2. Gonadal dysgenesis. 3. Surgical or radiation menopause.

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