The cessation of menses for 6-8 months in a women
45 years of age or older is known as Menopause. Changes in menstrual cycle
regularly occur as women progresses through her forties. There may be decreased
cycle interval or lapse of cycle with blood flow. The menses usually cease
between age of 50-52 years.
Premature menopause is characterized by permanent
cessation of menses before 35 years of age. It may be due to genetic predilection
or in association with diseases like rheumatoid arthritis or mumps affecting
Change in body organ with menopause
Vagina becomes smaller.
Labia becomes pale and dry in appearance and lose
Ligaments supporting uterus become lax and pro lapse
of uterus may become evident.
Uterus becomes smaller and if fibroid were present
then they markedly reduce in size.
Breast loses turgor, form and fullness.
Bones show osteoporosis characterized by decrease
bone density and fractures.
Increased tendency for body hair with male patterns
( e.g., mustache, and hair on chin)
Physiological changes in body
due to decreased estrogen
Hot flush is the hallmark of menopausal women.
This is characterized by sudden reddening of skin
over head, neck and chest along with feeling of intense body heat and perspiration.
The flush may last a few seconds or minutes.
Flushes appear to be more frequent and severe at
night or during times of stress.
These changes may last 1-2 years in most women but
may last for as long as 5 years in some women.
Person may have subjective awareness that a flush
is going to begin.
Estrogen therapy will decrease frequency and severity
Changes in menstrual function
Decrease in amount and duration of blood flow is
followed by complete cessation of menses.
If vaginal bleeding occurs after 12 months of complete
cessation of menses then a doctor should be consulted immediately and investigation
carried out to rule out uterus disease ( i.e. polyp, cancer, etc.). IT
SHOULD NEVER BE IGNORED.
It is characterized by decreased bone density. Patient
may have fractures of vertebral body ( compression fracture), humerus,
femur, forearm bones and ribs.
It is more common in white women than black women.
Bone loss may be more rapid in young women who have had ovary removal operation
or gonadal dysgenesis.
Exercise and proper diet have beneficial effect on
bone integrity and estrogen therapy can retard process of osteoporosis.
It has different symptoms like fatigue, headache,
nervousness, loss of libido, depression, insomnia, irritability, palpitation,
joint and muscle pains. Estrogen replacement therapy markedly improves
these symptoms over time.
Organ changes will cause Atrophic vaginitis, itching
of vulvovaginal area, pain during coitus and stenosis.
Increased frequency of urination, urgency and incontinence.
Increased chance of bladder infection.
These symptoms may improve with estrogen replacement
Changes due to excess estrogen
Dysfunctional uterine bleeding: There is irregular,
abnormal and large amount of bleeding.
Uterine cancer or hyperplasia: Also manifested
as increased bleeding. All women above 35 years of age with abnormal bleeding
would have D and C and endometrial biopsy to rule out cancer.
Treatment of these disorders is not with estrogen
therapy but can be decided individually after investigations.