Menopause

Definitions:

Perimenopause – woman aged over 45 years with vasomotor symptoms and irregular periods within the first 12 months of this change 

Menopause – woman aged over 45 years who has not had a period for at least 12 months and is not using hormonal contraception with menopausal symptoms 

Menopause is a natural stage in a woman’s life. It is characterised by the depletion of oocytes. Ovarian follicular activity fails and oestrogen levels drop. The reduced negative feedback loop to the pituitary gland causes raised levels of follicle stimulating hormone and luteinizing hormone. Insufficient estradiol production leads to a reduced stimulation of the endometrium causing amenorrhoea. It is thought that the low oestrogen level is responsible for many of the menopausal symptoms that women experience. 

A follicle stimulating hormone blood test should only be used to diagnose menopause in a woman aged 40-45 years with menopausal symptoms including a change to their menstrual cycle or in a woman aged under 40 years where menopause is suspected. 

As well as a change in the menstrual cycle, other symptoms often encountered during the menopause are: 

  • vasomotor symptoms (hot flushes and sweats) 
  • sleep disturbance (leading to issues of irritability and concentration)
  • mood changes (low or fluctuating mood)
  • urogenital symptoms (vaginal dryness)
  • musculoskeletal symptoms (joint and muscle pains)
  • sexual problems (reduced libido) 

 The lack of oestrogen in menopausal women increases their risk of: 

  • cardiovascular disease 
  • osteoporosis 
  • dementia and cognitive decline 
  • parkinsonism 

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