MENOPAUSE

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