Menopause

Defined by no periods of more than 1 year duration in a non-pregnant woman, due to cessation of ovarian oestrogen production

Average age = 51 years

Symptoms

• Hot flashes

• Night sweats

• Insomnia

• Headaches

• Mood changes (irritability, depression, anxiety)

• Poor concentration and memory

• Sleep disturbance

• Unusual tiredness

• Muscle or joint pains

• New facial hair

• Dry skin

• Crawling feelings under the skin

• Low libido, vaginal dryness, and/or uncomfortable or painful intercourse (often not reported)

• Urinary frequency

Duration

• No age limit for cessation

• 60% of women have symptoms 5 to 8 years

• Mean duration 8 years

• 20% have no symptoms

• 20% have symptoms into their 60s and 70s

Exclude

• Pregnancy or lactational amenorrhoea

• Functional hypothalamic amenorrhoea e.g., weight loss, eating disorders, excessive exercise, stress

• Polycystic ovarian syndrome (PCOS)

• Intrauterine device

• Depression and anxiety

• Anaemia

• Thyroid dysfunction

• Pituitary disease

• Hyperprolactinaemia

• Previous uterine surgery (Asherman syndrome)

• Medications

Management

Lifestyle advice

• Weight loss and smoking cessation help reduce hot flashes. See Australasian Menopause Society – Maintaining Your Weight and Health During and After Menopause.

• To avoid vasomotor triggers such as caffeine, alcohol, and spicy foods.

• Layer clothing and use natural fibres for clothing and bed sheets.

• To follow sleep hygiene advice and develop a fatigue management plan if appropriate.

• Practising relaxation techniques and mindfulness therapy may reduce the intensity of hot flashes as well as reduce tension, anxiety, and depression.

• Lifestyle advice for general health and optimal bone health includes:

  • Healthy nutrition.

  • Adequate calcium intake.

  • 150 minutes of physical activity per week, including some resistance exercise to assist BMD. Increasing physical activity is generally beneficial. In some patients exercise may worsen symptoms, however, possibly because of a risk in core body temperature.

  • Smoking cessation.

  • Alcohol in moderation (no more than 10 standard drinks per week, and no more than 4 standard drinks on any one day).

References:

• Diagnosis of menopause - Up To Date / Needs Log In