Menopause
last authored: Feb 2010, David LaPierre
last reviewed:
Introduction
Menopause describes the changes to the body occurring with the end of ovulation. It is defined as the cessation of menses after 12 months.
The mean age of onset is 51 for Canadian women. With an average life span of 81 years, a woman will spend over 1/3 her life in menopause.
The Case of Ms. Ukalai
Ms Ukalai is a 56 yearold woman who comes to her family doctor with 'terrible attacks of sweating'. She wonders if she is in menopause, and if hormone treatment will help her.
Physiologic Effects of Menopause
Menopause is typically preceded by a period of decreasing ovulations and increasing anovulatory cycles (perimenopause).
The cessation of estrogen production by the ovaries leads to endocrine, somatic, and physiologic changes. These include:
- hot flashes (with varying ethnic prevalence rates - Caucasian women higher than Asian)
- night sweats
- urogenital tract: atrophy, vaginal dryness, incontinence.
- blood vessels and heart: vasomotor instability, hot flashes, increased risk of CVD
- bone: bone loss, fractures, loss of height
- brain: depression, mood swings, memory loss, decreased libido
Treatments
Lifestyle measures have been demonstrated to be very effective at preventing disease. The most important appear to be exercise and smoking cessation. Diet is also important; women should supplement with 1500 mg calcium and /1,000 IU Vitamin D daily.
Hot flashes or vasomotor symptoms can be effectively treated with HRT. Other options include clonidine, venlafaxine, SSRIs, and gabapentin. The effect of black cohosh is controversial. Non-pharmacologic options include breathable clothing, ice packs, and fans for cooling, and relaxation techniques, yoga, biofeedback, and exercise.
Vaginal atrophy and other symtpoms can be treated with HRT, orally or locally. Lubricating gels may be helpful, along with Kegel exercises and decreased caffeine intake to help with incontinence.
Hormone replacement therapy (HRT)
HRT can be effective at treating menopausal symptoms, but the risks appear to be substantial. Its use continues to be supported for short-term use and for severe symptoms, but its benefit should be re-evaluated annually. A thorough discussion of the patient's wishes and desires, history, symptoms, and risk factors is very important.
HRT prevents:
- osteoporosis
- fracture
- colorectal cancer
- NO benefit for heart disease
HRT increases risk for:
- stroke
- DVT
- endometrial and ovarian cancer (unopposed estrogen)
- breast cancer
HRT may be given as estrogen only or estrogen plus progestin for women with an intact uterus. HRT can be given orally, transdermally, or vaginally.
Venlafaxine, SSRI, or gabapentin can all be used to help with vasomotor instability.
Additional Resources
any good free online resources for further reading.
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