Menopausal syndrome
Menopause is a natural biological process that every woman goes through. It is a gradual process taking on an average of four years to complete. Menopause happens when menstruation stops for at least twelve months. It marks the end of the reproductive period for a woman. It normally takes place at the age of 45 to 50 years.
Perimenopause
It happens before full menopause. It is a transitional period of two to eight years from the reproductive to non-reproductive (menopause) stage. This period is characterized by menstrual irregularity. It is associated with the progressive falling of estrogen hormone levels. The low estrogen level is because of the lack of ovarian follicles.
The fall of estrogen level causes the Follicle Stimulating Hormone (FSH) level to gradually increase. This happens due to the loss of negative feedback by estrogen. Normally (during the normal menstrual cycle) the FSH facilitates the maturation of the ovarian follicle, and these follicles ultimately produce estrogen. It is possible to get pregnant during the perimenopausal period.
Hormone changes in perimenopause
- In this period estrogen level can be low, normal, or slightly elevated (due to a high FSH level of around 20 IU/L).
- During perimenopause Anti Mullerian Hormone (AMH) level decreases which gives a higher chance of twin pregnancy. Therefore, contraception use is recommended.
- Inhibin B level decreases.
- Luteinizing hormone is increased due to a lack of negative feedback by estrogen (Similar to FSH). It results in the loss of cyclical LH surge.
- Testosterone level decreases due to hypoplasia of adrenal glands.
Risk factors for early menopause
- Smokers go to menopause much faster than non-smokers.
- Chemotherapy
- Radiotherapy
- Urinary tract infection
Symptoms of menopausal syndrome
- Psychological – depression, mood change, and mania.
- Neurological – headache, and memory loss.
- Hot flushes (Sudden feeling of warmth in the face or other parts of the body, 80% of women experience it).
- Night sweat
- Heart racing
- Joint pain
- Obesity
- Tiredness
- Hair loss
- Reduced sex drive
- Urological symptoms – the urgency of urination, dysuria, urinary incontinence, frequency of urination, and Increased chance of urinary tract infection.
- Vaginal symptoms – dryness, itching, painful intercourse, vaginal atrophy
Contact your GP if you have these symptoms before 45 years of age.
Diagnosis of menopausal syndrome
It is usually diagnosed by measuring FSH level. An elevated FSH level of more than 30 IU/L and 12 months of lack of menstruation can diagnose menopause. The premenopausal FSH level should be less than 10 IU/L. The estradiol level can also be measured. Estradiol level falls in menopause.
Treatment of menopausal syndrome
- Patient education
- Eating a healthy diet and dairy food
- Calcium and vitamin D supplementation to counter osteoporosis (bone thinning)
- Regular exercise
- Selective serotonin reuptake inhibitors for depression
- Local – for vaginal itchiness, topical estrogen ointments or creams
- Hormone replacement therapy – estrogen and progesterone
- Gabapentin
- Topical minoxidil can reduce hair thinning
Hormone replacement therapy (HRT)
It is given in the form of estrogen or a combination of estrogen and progesterone. HRT should be avoided if possible because it comes with the following side effects. If it is given then it should be given at a minimum dose and for a minimum period to alleviate the symptoms of the menstrual syndrome.
- Nausea or vomiting
- Pain in the breasts
- Weight gain
It also has some complications:
- Increased risk of breast cancer and endometrial cancer.
- Increased risk of blood clotting in the brain causing stroke or ischemic heart disease (heart attack).
Some terminologies
Surgical menopause
It happens after surgical removal of both ovaries (oophorectomy). There is a sudden fall in estrogen level in the blood and the body cannot cope up with this sudden hormonal imbalance. It is associated with the rapid onset of menopausal syndrome symptoms as discussed above. It usually requires hormone replacement therapy to control the symptoms.
Premature menopause
When menopause happens before 40 years of age it’s called premature menopause.
