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Menopause
The menopause is defined as the final
episode of menstrual bleeding in women. The term is used commonly to
refer to the transitional period up to and after the last episode of
menstrual bleeding. During this period, there is a progressive loss of
ovarian function and a variety of changes due to hormonal upset.
The median age of women at the time of
cessation of menstrual bleeding is 50 to 51 years. In the 5 years before
menopause there is gradual increase in the number of anovulatory cycles
- i.e. cycles without ovulation. During this period the estrogen
secretion falls and there is increased pituitary secretion of LH and FSH
hormones. The age of menopause
varies widely. Before the menopause the interval between the menses is
variable and it becomes longer and longer.
The menopause is the consequence of the
exhaustion of folicles in the ovaries of a female. The decrease in the
number of ova begins in the womb itself. By the time of the menopause,
few ova remain, and these appear to be nonfunctional. Only a small
number of ova are lost as the result of ovulation during reproductive
life. The stopping of follicular development results in decreased
production of estradiol and other hormones.
Estrogen and androgen levels in plasma
are reduced but not absent.
Clinical Features
| About 3 of 4 women experience menopausal
symptoms, but in 50 percent to 75 percent of sufferers they
last a year or less. In about one-third of sufferers, they
persist for up to five years, and in a small percentage, they
last longer. |
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Irregular
periods commonly precede the menopause. |
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Hot
Flashes and sweating. Hot flashes may start even when the
paerson still has regular periods. |
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Nervousness,
Anxiety, Emotional lability, Irritability, Depression. |
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Increased
Vaginal Infection, Vaginal dryness, atrophy of urogenital
epitheliom |
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Urgency
of micturition. |
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Decrease
in the size of breasts. |
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Approximately 40 percent of
menopausal women develop symptoms serious enough to seek medical
assistance. |
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Osteoporosis
- reduction of Calcium in bones, is one of the crippling
afflictions of aging, and there is a close relationship between estrogen
deprivation and its development. Approximately one-fourth of aging women
and one-tenth of elderly men sustain a vertebral or hip fracture between
the ages of 60 and 90, and the incidence is highest in elderly white
women. Such fractures are a major cause of death and morbidity.
Many factors affect the development of
osteoporosis, including diet, activity, smoking, and general health, and
estrogen deprivation is of particular importance.
White postmenopausal
women are more predisposed to osteoporosis and its consequences.
It is known that fall in the
secretion of estrogen is associated with initial rapid loss of
bone mass.
Vertebral compression fracture,
fracture neck femur and radius is seen more in females in
comparison to males. Those women who smoke are at a greater
risk. Excessive alcohol and lack of exercise add to this risk.
Earlier the menopause greater is the problem. Oestrogen started
at the time of menopause is show to prevent the bone loss. |
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After the menopause women experience an
increase in the incidence of cardiovascular disease. |
Management
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Many
women do not need any treatment. Explaining the problem and
reassurance is what most of them need. |
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Hot
flashes and sweating - may be helped by Clonidine 50 µg
twice daily. But in many patients estrogen therapy is
required. |
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Oestrogen
Replacement Therapy
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Oral
Oestrogen - cyclical Ethinyl oestrogen 0.01-0.02 mg
/ day for 21 days with Medroxyprogesterone acetate 5 mg
daily for the last 10 days. |
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Percutaneous
Patches with reservoir of oestradiol 25-50 µg /
day. Change every 3-4 days. Add oral Progestogen for 10
days per month. |
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Topical
oestradiol - for Atrophic Vaginitis 0.01 %
Dienoestrol cream. |
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About 17 million women in the United States take hormones to
relieve menopausal symptoms including hot flashes, sleep
disturbances and vaginal dryness.
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