Summary of the Physical symptoms of menopause

-Tiredness

-Hot flushes

-Night sweats

-Insomnia

-Vaginal dryness

-Urinary frequency

Summary of the Psychological symptoms of menopause

-Mood swings

-Anxiety

-Loss of short-term memory

-Lack of concentration

-Loss of self-confidence

-Depression

i) Hot flushes:

This is the second most common symptom of menopause (after irregular menses and cessation of menses). It occurs in 80% of women.

Hot flushes presents as feelings of intense heat over the trunk and face. This is associated with flushing of the skin and sweating. Hot flushes may occur prior to the cessation of the menses.

Women who have surgical menopause may have very severe hot flushes.

Hot flushes are more severe during hot weather and more pronounced in the latter part of the day.They are also more severe after eating hot foods and drinks and periods of tension. Hot flushing frequently occur at night causing sweating and insomnia.

Hot flushes are attributed to an increase in pulsatile release of GnRH (Gonadotrophic releasing hormone) from the hypothalamus. This is beleived to affect adjacent temperature regulating areas of the brain.

ii) Cessation of menstruation:

As menopause approaches menstrual cycles become irregular. The cycles are often anovular (like during menarche) .The length of the cycle may also be irregular. There might be menorrhagia occasionally.

Due to the decreased secretion of oestrogen, the menstrual flow usually decreases in amount. The low oestrogen level causes a decrease in the size of the endometrium.

Before menses finally cease the cycles become longer, with missed periods or episodes of spotting.

Menopausal transition is said to have occurred if there has been no bleeding for 1 year.

Any bleeding that occurs after a period of one year (post-menopausal bleeding) warrants thorough investigation to rule out endometrial cancer.

iii) Osteoporosis:

A late sequel of menopause in some women is osteoporosis.

iv) Vaginal Atrophy:

The vaginal walls become thinner after menopause due to low levels of oestrogen. Thinning of vaginal mucosa and decreased vaginal lubrication may also lead to dyspareunia (painful coitus). There is also decrease in diameter of the introitus.

Pelvic examination will reveal a small cervix and uterus. The vagina will be pale and the ovaries are usually not palpable after menopause.

Management is by continued sexual activity which will help prevent tissue shrinkage. In severe cases oestrogen cream may be helpful

v)Urinary symptoms:

Frequency dysurea and urgency are frequent symptoms experienced by menopausal women. Although these symptoms suggest urinary tract infection (UTI) ,they are not associated with a positive urine culture.

There are oestrogen receptors in the trigone of the bladder and the proximal urethra. These may explain the symptoms, but in all cases a urine culture must be done before attributing it to menopause.

Stress incontinence is also frequent in menopausal women,but interovaginal prolapse must always be excluded.

It is important to note that the symptoms of menopause are highly variable . It can vary from absent, fleeting and mild to very severe. In some women the symptoms may continue for many years.

References:

Pages 227 to 229. Chapter 19. Menopause. Gynaecology by ten teachers. Seventeenth edition. Edited by Stuart Campbell and Ash Monga.

Pages 760 to 762. Chapter 17. Menopausal syndrome.Gynaecology. CMDT 2006. Current Medical Diagnosis and Treatment 2006.45 th Edition. Edited by Lawrence M. Tierney,Jr. Stephen J McPhee, Maxine A. Papadakis.

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