What is menopause?
Menopause is defined as the time at which menstruation (periods) stops. Menopause is said to have occurred only one year after the stoppage of menstruation. Menopause occurs between the ages 45 and 55 years. The average age of menopause is 47 years. However there are some women who menstruate well beyond the age of 50. This prolongation of menstrual activity may be due to the improvement in general health. A menopause before the age of 40 years is called premature menopause.
What are the changes in the body that occur during menopause?
Once the menopause is established, the estrogen level is the blood may remain low due to the reduced production of the hormone by the ovaries. The genitalia undergo atrophy and regression. The ovaries become shrunken and their surfaces appear grooved and furrowed. The muscles in the fallopian tube undergo shrinkage. The uterus and cervix becomes smaller. The vagina becomes smaller and the vaginal mucosa becomes pale, thin and dry. The vulva also shrinks and the vaginal orifice becomes smaller. This causes pain during intercourse. The pubic hair is reduced in amount and the color becomes grey. Fat is deposited around the breasts, hips and abdomen. In some women osteoporosis may develop after menopause.
What are the symptoms experienced by the woman during and after menopause?
- he menstruation may stop suddenly or gradually over a period of time.
Neurological and emotional:
- uring the menopause, the commonest symptoms are hot flushes and sweating which occurs in 85% of the women. The hot flushes are worse in the night time. Mental depression may be caused by night sweats. Coronary heart disease is common after menopause due to estrogen deficiency.
What are the investigations to be done in patient with menopausal symptoms?
- Sensation of pins and needles over the limbs is common. Headache and noises in the ear may occur. Irritability and depression may be seen in some women.
- Joint pain, backache can occur in menopausal woman. Muscle pain, vertebral disc problems are common after menopause.
- Osteoporosis: Decrease in the calcium content in the bone during advancing age is called osteoporosis. At the age of 40, total bone calcium is 1200grams. When the calcium level reaches 750 mgs, the woman becomes susceptible to fracture.
- Urinary tract: Patient may have burning sensation while urination, urethral infection and urinary leakage during straining and coughing (stress incontinence)
- Endocrine system: Increased growth of hair may be seen over the face. Dryness in the skin and reduction of mental power and concentration may develop.
- Genital tract: The vagina becomes dry and cervix undergoes shrinkage. The uterus diminishes in size.
What is the treatment of menopausal symptoms?
- Blood pressure should be checked. Weight should be noted. Presence of excess hair in the body (hirsutism) if any should be looked for.
- Examination of breast for any mass and vaginal examination to be done.
- Blood sugar and lipid profile
- ECG and chest X ray
- Bone study to rule out osteoporosis.
The patient often fears pregnancy and possibility of cancer at the menopause. Thorough examination should be done by the gynecologist. A thorough breast examination and pelvic examination should be done. The patient should be checked for diabetes. Pelvic ultrasound is helpful in measuring the size of uterus and to rule out any fibroids in uterus or any lesion in the ovary.
- A mild sedative may be helpful in treating menopausal symptoms like depression, sleeplessness and palpitation.
- Estrogen therapy: The most severe menopausal symptoms need estrogen therapy. Estrogen therapy over a short period of a few months will relieve the patient of hot flushes, night sweats, palpitations and disturbed sleep. Estrogen therapy will also relieve painful intercourse and vaginal dryness. It is also useful in delaying osteoporosis.
- Daily intake of calcium tablets and walking for half an hour will help in treating osteoporosis.
- To avoid an old look and to maintain libido and sexual satisfaction, cyclical estrogen therapy with added progesterone is helpful in menopausal women but there are risks like vaginal bleeding, liver and gall bladder disease and breast cancer. Estrogen vaginal cream and patches are more helpful for this purpose.
- Clonidine therapy is useful in preventing hot flushes. It is useful in menopausal women not responding to estrogen therapy.