Menopause

Natural cessation of a woman's menstrual cycle, marks the end of fertility

Aetiology

  • Average age in UK of menopause is ~51 years
  • Premature ovarian insufficiency (POI): <40 years (1%)
  • Early menopause: 40-44 years (5%)

Clinical presentation

  • Mood swings
  • Night sweats
  • Hot flushes
  • Lack of energy
  • Lack of sex drive
  • Depression, anxiety
  • Period problems
  • Headaches
  • Irritability
  • Insomnia
  • Symptoms most severe in late peri- and early post menopause
  • Most symptoms improve with time except genitourinary problems (dry vagina, painful sex, urinary symptoms)

Investigations

  • FSH levels 2 x (6 weeks apart) indicated:
    • In women > 45 with atypical symptoms
    • In women between 40 and 45 with menopausal symptoms and/or iatrogenic amenorrhoea (TAH, endometrial ablation etc.)
  • FSH, E2, TFT, glucose, prolactin and FAI should be checked:
    • In women < 40
    • Check also chromosomes and exclude autoimmune disorders in women <35

Management

Lifestyle changes

  • Healthy diet
  • Healthy weight
  • Regular exercise
  • Good sleep hygiene
  • No smoking
  • Limited alcohol and caffeine
  • Reducing stress (yoga, mindfulness, relaxation techniques etc.)
  • CBT

'Environmental' changes

  • Cooler ambient temperature
  • Good ventilation
  • Suitable clothing
  • Neck, hand-held or desk fans
  • Neck cooling scarf
  • Cooling spray

Non-hormonal medical treatment

  • Herbal medicine - St. John's Wart etc.
  • Non-hormonal medical treatments - antidepressants, gabapentin
  • Complementary medicine - acupuncture, homeopathy

HRT

  • Consider therapeutic trial with HRT independent from blood results and/or amenorrhoea
  • Very effective symptomatic control however has contraindications (history of breast cancer, CHD, TIA/stroke, unexplained vaginal bleeding, active liver disease)
  • Women with premature ovarian insufficiency - give HRT until the average age of menopause
    • CHC could be considered as alternative unless CI
    • Continue with contraception
  • Women with early menopause - consider strongly giving HRT until the average age of menopause