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Menopause is defined as the stopping of a women's
menstrual periods. Menopause may also be the result of surgical intervention or drug
effect, particularly that of chemotherapeutic agents. The average age of menopause in the
United States is approximately 51 years of age. Evidence of menopause before the age of
35–40 is designated premature menopause and usually necessitates a workup to
determine its possible cause.
Symptoms
Typical symptoms include:
1. Cessation of menstruation. Menstrual cycles generally become irregular as menopause
approaches. Finally, cycles become longer with missed periods or episodes of spotting
only. When no bleeding as occurred for one year, the menopausal transition can be said to
have occurred. Any bleeding after this time warrants investigation to rule out cancer.
2. Hot flushes (feeling of intense heat over the trunk and face with flushing of the skin
and sweating). Flushing is more pronounced late in the day, during hot weather, after
ingestion of hot food or drinks, or during periods of tension. Occuring at night, they
often cause sweating and loss of sleep and result in fatigue on the following day.
3. Vaginal atrophy. This means that the lining of the vagina becomes thin and there is a
decreased amount of vaginal fluids. This may lead to pain during intercourse.
4. Osteoporosis (decrease of bone mass).
Treatment of menopausal symptoms
1. Estrogen replacement therapy. This may be used to treat the symptoms of menopause and
osteoporosis. In particular, it is very useful to decrease the severity of hot flushes
which will probably return if the hormone is discontinued. Estrogen has a beneficial
effect for the prevention of heart disease. However, the main concern with its use is that
it could possibly cause uterine cancer. It is believed, that by combining it with
progesterone, this risk decreases. Hence, this combination is frequently used. It should
be emphasized that patients with family or previous history of breast cancer, use of
estrogen should be very restricted since this hormone could cause breast cancer in these
individuals.
2. Natural methods to decrease the severity of hot flushes include daily exercise,
electroacupuncture, relaxation practices, and avoiding caffeine and alcohol.
3. Regular exercise, calcium, medications such as miacalcin nasal spray, fosamax are
helpfulin the treatment osteoporosis. In particular, a new medication by the name of
Raloxifene has estrogen-like benefits without the risk of affecting the uterus and
possibly causing uterine cancer.
Follow-up examinations
The patient should be periodically followed-up, every 3–6 months after initiating
hormone replacement therapy, to determine the adequacy of the hormone regimen and review
any side effects. Once an appropriate regimen has been established, the patient should be
evaluated on a personal basis.
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