Menopause

Menopause is the permanent cessation of menstruation. It occurs when the ovaries stop producing oocytes.

It is a normal event in the life of a woman that marks the transition from the reproductive period to the non-reproductive period. We consider a woman to have entered menopause when menstruation has stopped for at least 6 months.

Any vaginal bleeding 6 months after the last menstrual period requires immediate medical examination.

According to the Μassachusetts Women’s Health Study the median age of menopause is 48-52 years old.
The age of menopause has nothing to do with the age of menarche, contraception or socioeconomic factors.

Short-term consequences

A significant proportion of postmenopausal women have hot flushes (about 70%). But only 20% will be affected enough to seek medical attention.

A characteristic of hot flushes is the increase in body temperature and the woman feeling hot, usually uncomfortably hot. Women describe hot flushes as periods of intense flushing, heat and sweating. It begins in the face and they often feel in the neck and chest. Hot flushes are sometimes followed by chills.

Atrophic changes lead to a variety of symptoms that affect the quality of life. Vaginal dryness, itching, dyspareunia (pain during sexual intercourse), urethritis, recurrent urinary tract infections and urinary incontinence may be the result of atrophic epithelial atrophy.

Long-term consequences

The lack of estrogen accelerates the rate of bone loss by 0.5-2% per year. Loss of bone mass results in reduced skeletal resistance and increases the risk of fractures. The most common fractures are the vertebrae, the neck and head of the femur and the distal end of the trunk (Colles fracture). Even a minor trauma can cause fracture.

Estrogen deficiency affects blood lipids, leading to increased cholesterol and LDL

These changes may explain the increase in cardiovascular disease and atherosclerosis often seen after menopause.

The effects of estrogens on the brain are neurotrophic and neuroprotective and therefore syndromes that include impaired mental functions (eg Alzheimer’s disease) may be related to their deficiency.

Postmenopausal bleeding

Postmenopausal hemorrhage should receive special attention from the gynecologist and the woman. The first reason that the doctors have to exclude is neoplasia. The doctor should also perform an ultrasound examination, Pap smear and hysteroscopic endometrial biopsy.

Therapy

The gynecologist valuates the symptoms which vary from patient to patient. After the necessary examinations (history of cancer, pap test, mammography, blood exams, bone mass measurement and a thorough clinical examination) he will decide which treatment to follow. It is essential that the only indication of hormone replacement is a decrease in woman’s quality of life. Otherwise it should not be given. The woman should always control and treat osteoporosis.

Treatment can be hormonal or natural (phytoestrogens).