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Menopause

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Menopause

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This short chart can help the GP look at the various definitions around menopause and explain to the women the difference between an early menopause and menopause.The presentation of menopause is discussed along with the complications. That this can be diagnosed without investigations can be seen clearly under the heading- diagnosis. Often requested along with FSH but LH has little role in the diagnosis of the menopause. The GP should note that premature menopause should not be diagnosed on a basis of a single blood test and that no cause is found in the majority of the cases of premature menopause. Please also look the chart HRT which can help in completing the process of diagnosing and management of menopause.

Menopause- Permanent cessation of ovarian function and menses for 12 consecutive months Loss of ovarian follicular activity UK and N America mean age 51 
( may vary between ethnic groups )

Perimenopause- Also called climacteric ( Greek- rung of ladder ) Climb to menopause Time before menopause when endocrinological , biological and clinical features of approaching menopause commence Avg age 45-47 Irregular cycles of ovulation and menstruation 
( shortening follicular phase and anovulatory cycles ) Ends 12 months after the last menstrual period

Early menopause-Less than 45 yrs

Premature menopause-Menopause before age of 40 yrs
 
also called ” premature ovarian insufficiency” or 
”premature ovarian failure” No cause 
found in majority of cases

Loss of normal ovarian function before age of 40 Consider in ♀ < 40 with
♦ menopausal symptoms including no or infrequent periods
♦ ↑ FSH levels on 2 blood samples take 4-6 week apart

Do not diagnose on the basis of a single blood test
 Three main causes are

♦ Genetic → strong family hx , galactosaemia and chromosomal abnormalities ( chrmosomal analysis )

♦ Autoimmune → may happen with or without other autoimmune diseases ( consider autoimmune screen for polyendocrinopathy)

♦ Iatrogenic→ result of treatments as chemotherapy , radiotherapy and surgery
 Infections as 
♦ TB 
♦ Mumps ( usually ovarian function returns to normal)
♦ Malaria
♦ Varicella
♦ Shigella. Treatment with HRT or COCP till atleast
 age of natural menopause

Post-menopause-No period for 12 consecutive months

Signs and symptoms –Vasomotor symptoms
♦ hot flushes
♦ night sweats
 Urogenital symptoms
♦ vaginal dryness
♦ irritation , discharge 
♦ dyspareunia
♦ postcoital bleeding
♦ prolapse
♦ recurrent UTI’s
♦ urinary frequency , urgency
♦ dysuria ,voiding difficulties
♦ urinary incontinence
 Psychological symptoms
♦ Depression and mood change
♦ Anxiety / irritability
♦ Memory loss
♦ Poor concentration
♦ Sleep disturbance
 Musculoskeletal symptoms
♦ joint and muscle aches and pains
 Sexual disorders
♦ problems with sexual intercourse
♦ vaginal dryness → pain during intercourse
♦ loss of libido. Vasomotor symptoms 
are most common -
75 % ♀ with 25 % being severely affected

Symptoms can 
last upto 2-5 yrs with
 median duration 
of 7 yrs or longer

Implications- Decrease in bone mass- Osteoporosis ↑ in cardiovascular risk Urogenital atrophy

Test FSH-♀ aged > 45 yrs with atypical symptoms ♀ between 40-50 with menopuasal symptoms including a change in their menstrual cycle ♀ < 40 yrs → if premature menopause suspected

Luteinizing hormone Oestradiol Progesterone

 Testosterone – uncertain value BMD – if high risk osteoporosis- have no role in diagnosing menopause

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