Menopause is the cessation of menstruation in a female and usually spontaneously occurs at the age of 45-55 years. Perimenopause is the time around menopause and can last a few years until the menopause has set in.
Menopause can also be caused by surgical removal of ovaries.
Clinical features
Hot flushes
(sudden unanticipated, unpleasant wave of body heat; can range from mild to intense)- Night sweats, palpitations, headaches, insomnia, tiredness
- Irregular menstruation till cessation
- Vaginal atrophy and dryness, loss of libido, painful intercourse
- Bladder irritability, incontinence, UTIs
- Weight gain (sometimes)
- Skin changes: dryness, thinning, loss of head hair, increase or loss of body hair)
- Mood swings, emotional changes (e.g. depression, irritability, short temperedness, weepiness)
- Lack of concentration, failing memory
- Osteoporosis, denture problem
Investigations
- Exclude pregnancy
Management
Non-pharmacological
- Explain process of menopause to the patient and reassure her it is normal
- Suggest lifestyle adjustment
- Follow a healthy diet
- Sleep and exercise enough
- Wear loose light clothing
- Avoid alcohol
- Diet low in fats, high in fruit and vegetables
- Food rich supplements such as magnesium, vitamin B1, vitamin E and zinc
- Calcium-rich food (or supplements) such as milk and soya beans and vitamin D supplements
- Screen for CVD (hypertension, heart disease) and urine incontinence
- For severe symptoms (severe hot flushes, depression) consider
- Fluoxetine 20 mg daily
- NB: URGENTLY REFER ANY MENOPAUSAL WOMAN WITH VAGINAL BLEEDING FOR
FURTHER ASSESSMENT