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 ovaries.
 

Change in body organ with menopause

• Vagina becomes smaller.
• Labia becomes pale and dry in appearance and lose their fat.
• 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 of flushes.

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.

Osteoporosis

• 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.

Menopausal syndrome

• 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

• 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 therapy.

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.