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Menopause

Updated 20 July 2014

Menopause

Menopause means the cessation of menstruation. It is a normal life event that indicates the end of a woman's fertility.

Summary

  • Menopause is a normal life event that designates the end of a woman's fertility.
  • Ovarian production of eggs and female hormones, as well as menstruation, decreases and eventually stops.The hormonal changes are often accompanied by characteristic symptoms, such as hot flushes, anxiety, poor memory, emotional instability and decreased sexual urge.  
  • The hormonal changes are often accompanied by characteristic symptoms, such as hot flushes, anxiety, poor memory, emotional instability and decreased sexual urge. 
  • Premenopause begins in the mid-40s and lasts until menopause, which occurs at an average age of about 51.
  • Long-term health effects during the post-menopausal phase include increased risk of osteoporosis and heart disease. 
  • Treatment of symptoms may include positive lifestyle modification and prescription therapies such as hormone therapy. (HT)
  • HT is the only treatment which will alleviate all symptoms of menopause.
  • There is unfortunately little scientific evidence to promote the efficacy of black cohosh and other herbal remedies, and plant oestrogens (bio-equivalnet hormones). 

Description

Cause

Diminishing oestrogen leves as a reslt of decreasing ovarian function cause menopausal symptoms. When you enter  the menopause, your periods end because your ovaries no longer release eggs for fertilisation every month. As a result, production of the female hormone oestrogen stops. In normal circumstances, egg-cell production stops when the number of eggs a woman was born with has been exhausted, or their quality has deteriorated.

Natural versus induced

Symptoms of perimenopause and menopause

  • Spotting between menstrual periods
  • Periods that last more than seven days (or two days longer than usual)
  • Very heavy or gushing flow
  • Bleeding from the vagina during intercourse

  • Painful intercourse due to vaginal dryness (atrophy)
  • A woman’s perception of her changing body
  • Incontinence which could lead to sexual avoidance
  • Sleep disturbances due to night sweats
  • Depression, stress and anxiety
  • Many medications, including some anti-depressants
  • Reduced libido and impotence in the male sexual partner

How menopause harms the body

Effect on the skeletal bones

Effect on the heart

Effect on fat distribution, muscle mass and skin

Effect on the brain

Effect on fertility

When to see a doctor

  • You have prolonged irregular bleeding. This may be particularly important if you are overweight.
  • You experience bleeding after not having had a period for six months or more; among other possibilities, it may be a sign of uterine cancer.
  • Mood changes are causing problems. If depression is severe or persists for more than two weeks, consult your doctor.

Diagnosis

Treatment

  • Healthy with no problems
  • Healthy, but with significant risk factors for osteoporosis and/or heart disease
  • Medically compromised, for example has had a heart attack, stroke, breast cancer, diabetes etc.

  • lifestyle modification and home treatment
  • nonprescription remedies and
  • prescription therapies, including hormone therapy.

Lifestyle modification and home treatment

Prescription medication

The main ways in which HT is given are

  • Oral – by mouth
  • Across the skin – percutaneous/transdermal– as gels or patches (one of the safest options)
  • As implants
  • As a nasal spray ( not available in SA)
  • As an injection
  • In a hormone-impregnated intrauterine device
  •  Via the vagina as creams, foams, pessaries or oestrogen-impregnated rings

  • Your menopause started recently,  you are younger than 60 years and suffer severly from hot flushes and other menopausal symptoms.
  • Your menopause started recently, you are younger than 60 years and suffer severly from hot flushes and other menopausal symptoms, and are at risk for hip fractures. You may benefit from HT combined with anti-osteoporosis drugs.
  • you suffer from premature menopause (before 45 years of age). This should be treated to prevent the changes that occur due to the lack of hormones happening too early. Studies show that this prolonged exposure to hormones does not increase breast cancer risk or any other risks (besides clots). Once the natural age of the menopause is reached , the risks are the ame as for any other woman. 

  • a personal or family history of blood clots, stroke or breast cancer.
  • older than 60 and who had never taken HT before.
  • a family history of breast cancer or a personal history of breast lump should not take combined oestrogen and progestin therapy.
  • with a family or personal history of or increased risk for heart disease, stroke, deep vein thrombosis or hypertension.
  • elevated cholesterol or lipid levels. Talk to your doctor about statins as studies show women are under-treated in this regard.
     

 

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