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Menopause Information - Sign & Symptoms of Menopause and its treatment

Alternative names :- Perimenopause; Postmenopause

Menopause is the cessation of menstruation. It results from a complex syndrome of physiologic changes, called the climacteric, caused by declining ovarian function. The climacteric produces various body changes, the most dramatic being menopause.

Menopause is a normal change in a woman's life when her period stops. That's why some people call menopause "the change of life." During menopause a woman's body slowly makes less of the hormones estrogen and progesterone. This often happens between the ages of 45 and 55 years old. A woman has reached menopause when she has not had a period for 12 months in a row (and there are no other causes for this change). As you near menopause you may have symptoms from the changes your body is making. Many women wonder if these changes are normal, and many are confused about how to treat their symptoms.

What causes Menopause?

Menopause occurs in three forms:

  • Physiologic menopause, the normal decline in ovarian function due to aging, begins in most women between ages 40 and 50 and results in infrequent ovulation, decreased menstrual function and, eventually, cessation of menstruation (usually between ages 45 and 55).
  • Pathologic (premature) menopause, the gradual or abrupt cessation of menstruation before age 40, occurs idiopathically in about 5% of women in the United States. However, certain diseases, especially severe infections and reproductive tract tumors, may cause pathologic menopause by seriously impairing ovarian function. Other factors that may precipitate pathologic menopause include malnutrition, debilitation, extreme emotional stress, excessive radiation exposure, and surgical procedures that impair ovarian blood supply.
  • Artificial menopause may follow radiation therapy or surgical procedures such as oophorectomy.

Signs and symptoms of Menopause

Many menopausal women are asymptomatic, but some have severe symptoms. The decline in ovarian function and consequent decreased estrogen level produce menstrual irregularities, such as a decrease in the amount and duration of menstrual flow, spotting, and episodes of amenorrhea and polymenorrhea (possibly with hypermenorrhea). Irregularities may last a few months or persist for several years before menstruation ceases permanently.

Artificial menopause produces symptoms within 2 to 5 years in 95% of women. Cessation of menstruation in pathologic and artificial menopause is commonly abrupt and may cause severe vasomotor and emotional disturbances. Menstrual bleeding after 1 year of amenorrhea may indicate organic disease.

These body system changes may occur (usually after the permanent cessation of menstruation):

  • Reproductive system - Menopause may cause shrinkage of vulval structures and loss of subcutaneous fat, possibly leading to atrophic vulvitis; atrophy of vaginal mucosa and flattening of vaginal rugae, possibly causing bleeding after coitus or douching; vaginal itching and discharge from bacterial invasion; and loss of capillaries in the atrophying vaginal wall, causing the pink, rugal lining to become smooth and white. Menopause may also produce excessive vaginal dryness and dyspareunia due to decreased lubrication from the vaginal walls and decreased secretion from Bartholin's glands; smaller ovaries and oviducts; and progressive pelvic relaxation as the supporting structures lose their tone because of the absence of estrogen.

As a woman ages, atrophy causes the vagina to shorten and the mucous lining to become thin, dry, less elastic, and pale as a result of decreased vascularity. In addition, the pH of vaginal secretions increases, making the vaginal environment more alkaline. The type of flora also changes, increasing the older woman's chance of vaginal infections.

  • Urinary system - Atrophic cystitis due to the effects of decreased estrogen levels on bladder mucosa and related structures may cause pyuria, dysuria, and urinary frequency, urgency, and incontinence. Urethral carbuncles from loss of urethral tone and mucosal thinning may cause dysuria, meatal tenderness, and hematuria.
  • Mammary system - Breast size decreases due to decreasing size of mammary glands and ducts.
  • Integumentary system - The patient may experience loss of skin elastidty and turgor due to estrogen deprivation,loss of pubic and axillary hair and, occasionally, slight alopeda.
  • Autonomic nervous system - The patient may experience hot flashes and night sweats (in 60% of women), vertigo, syncope, tachycardia, dyspnea, tinnitus, emotional disturbances (irritability, nervousness, crying spells, fits of angerl, and exacerbation of preexisting depression, anxiety, and compulsive, manic, or schizoid behavior.
  • Musculoskeletal system - Menopause may also induce atherosclerosis, and a decrease in estrogen level contributes to osteoporosis.
  • Cardiovascular system - Ovarian activity in younger women is believed to provide a protective effect for the cardiovascular system, and the loss of this function at menopause may partly explain the increased death rate from myocardial infarction in older women. Also, estrogen has been found to increase levels of high-density lipoprotein cholesterol.
Diagnosis information

The patient history and typical clinical features suggest menopause. A Papanicolaou (Pap) test may show the influence of estrogen deficiency on vaginal mucosa. Radioimmunoassay shows these blood hormone levels:

  • estrogen: 0 to 14 ng/dl
  • plasma estradiol: 15 to 40 pg/ml
  • estrone: 25 to 50 pg/ml.

Radioimmunoassay also shows these urine values:

  • estrogen: 6 to 28ug/24 hours
  • pregnanediol (urinary secretion of progesterone): 0.3 to 0.9 mg/24 hours.

Follicle-stimulating hormone production may increase as much as 15 times its normal level; luteinizing hormone production, as much as 5 times.

Pelvic examination, endometrial biopsy, and dilatation and curettage may rule out organic disease in patients with abnormal menstrual bleeding.

Treatment of Menopause

Estrogen is the treatment of choice in relieving vasomotor symptoms and symptoms caused by vaginal and urethral mucosal atrophy. It also improves mood, helps prevent osteoporosis, and reduces the morbidity and mortality associated with cardiovascular disease. Because recent studies have identified a possible link between estrogen replacement therapy (ERT) and breast cancer, the patient should first have a screening mammogram.

ERT may be administered cyclically or continuously. Patients usually receive the lowest dosage that effectively treats symptoms and prevents osteoporosis. Severe hot flashes may require a higher dosage for a limited period, followed by a gradual reduction in the standard dose.

In women who haven't had hysterectomies, the addition of a progestin (such as medroxyprogesterone [Provera)) during the last 12 days of estrogen administration lowers the incidence of hyperplasia and endometrial cancer. In women who have had hysterectomies, progestin's relationship to breast cancer is unknown.

The oral route is preferred for estrogen-progestin therapy; the transdermal route reduces GI adverse effects such as nausea, and topical estrogen relieves symptoms of vaginal atrophy. Regardless of the route, the patient must understand the risk of endometrial hyperplasia and have regular checkups to detect it early.

Contraindications for ERT include unexplained vaginal bleeding, liver disease, recent vascular thrombosis, breast cancer, and endometrial cancer. If ERT is contraindicated, medroxyprogesterone, megestrol, and clonidine may reduce the incidence of hot flashes. Psychotherapy and drug therapy may relieve psychological disturbances.



Herbal Remedies have been used for centuries, to help the body balance during menopause. These are some of the more commonly used herbs for menopausal support from Herbal Remedies.

  • A paste made from aloe vera and slippery elm powder, mixed to the consistency of toothpaste and inserted into the vagina at night, can relieve vaginal dryness.
  • Damiana herbs enhances sexual desire and pleasure.
  • Chamomile and valerian root help to clam the body and promote restful sleep.
  • FemVitále herb, has been shown to be an extremely effective health tonic for relieving the many discomforts associated with menstruation and menopause.
  • Evening Primrose Oil is good for anyone interested in a natural source of essential fatty acids needed by the body. It is especially helpful in treating premenstrual syndrome (PMS), menstrual cycle irregularities, menopause, and endometriosis.


Special considerations and Prevention

  • Provide the patient with all the facts about ERT. Make sure she realizes the need for regular monitoring.
  • Before ERT begins. have the patient undergo a baseline physical examination, Pap test, and mammogram.
  • Advise the patient not to discontinue contraceptive measures until cessation of menstruation has been confirmed.
  • DO NOT smoke -- cigarette use can cause early menopause.
  • Tell the patient to immediately report vaginal bleeding or spotting after menstruation has ceased.
  • Take calcium and vitamin D.
  • Control your blood pressure, cholesterol, and other risk factors for heart disease

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