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 the majority between 45-55. 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 year-old 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 soy, black cohosh, and evening primrose oil is controversial. Non-pharmacologic options include breathable clothing, ice packs, and fans for cooling; and relaxation techniques, yoga, biofeedback, and exercise.
Vaginal atrophy can be treated with topical estrogen or lubricating gels may be helpful. Kegel exercises and decreased caffeine intake to help with incontinence.
Low mood can be treated with venlafaxine or desvenlafaxine.
Hormone replacement therapy (HRT)
HRT can be effective at treating menopausal symptoms, but with some potential health impacts.
HRT comes in many forms:
- oral estrogen, both synthetic and natural
- estrogen patch once weekly or twice weekly
Its use continues to be supported for short-term use - under five years - 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:
|
HRT increases risk for:
|
It should be started in women from 50-59.
Questions to be asked:
- smoker
- alcohol
Additional Resources
Menopause Update 2009 - Journal of Obstetricians and Surgeons of Canada
MenopauseandU.ca - website from the Society of Obstetricians and Surgeons of Canada
Narod SA. 2011. Hormone replacement therapy and the risk of breast cancer. Nat Rev Clin Oncol.
Topic Development
authors:
reviewers:
 |