Menopause Syndrome

INTRODUCTION

The menopause is the cessation of the menses for longer than 12 months. Up to 80% of women experience vasomotor symptoms for an average of 5 yrs (range 1–10); 20% will be severely affected.

Symptoms

• Vasomotor, e.g.:

  • – hot flushes (80%)

  • – night sweats (70%)

  • – palpitations (30%)

• Psychogenic, e.g.:

  • – tearfulness/depression

  • – irritability

  • – anxiety/tension

• Urogenital (60%), e.g.:

  • – atrophic vaginitis

  • – vaginal dryness (45%)

  • – dyspareunia

• Musculoskeletal, e.g. non-specific muscular aches

• Skin and other tissue changes, e.g. dry skin, formication

• Other, e.g.:

  • – unusual tiredness

  • – headache

Investigations

Apart from a cervical screening test, consider the following tests:

• urinalysis (if urinary symptoms)

• FBE, lipids incl. HDLC and fasting glucose

• liver function tests

• mammography (if due)

• diagnostic hysteroscopy and endometrial biopsy if undiagnosed vaginal bleeding

• bone density study (if risk factors)

If diagnosis in doubt (e.g. perimenopause; younger patient <45 yrs; hysterectomy):

MENOPAUSAL HORMONE THERAPY (MHT)

MHT has to be tailored to the individual patient and depends on several factors, incl. the presence of a uterus, individual preferences and tolerance. In women without contraindications, MHT carries few risks if initiated <60 yrs of age or within 10 yrs of menopause.

Vaginal dryness

First-line therapy is non-hormonal, e.g. Replens or K-Y gel. Second-line is a low dose vaginal oestrogen cream or pessary.