“12 months of amenorrhoea (no menstruation)

Risk Factors
  • Age – median age 51
    • Early <45
    • Premature <40.
Aetiology
  • Ovarian insufficiency and neuroendocrine change
Pathophysiology
  • Fall in oestrogen level → ceases in monthly ovulation
    • Oocyte atresia accelerated – reproductive ageing.
    • Decreased neurotransmitter (serotonin): psychological symptoms
    • Vasomotor symptoms due to narrowing of the thermal neutral zone
    • Decreased collagen in the skin
    • ↓ oestrogen: Dysuria and pain due to sexual intercourse from vaginal atrophy
Clinical Presentation
  • Common:
    • Hot flushes
    • Night sweats
    • Irregular periods
    • Loss of libido
    • Vaginal dryness
    • Mood swings
  • Cognition:
    • Fatigue
    • Sleep disorders
    • Difficulty concentrating
    • Memory lapses,
  • GI:
    • Bloating
    • Body odour
    • Irregular heartbeat
    • Anxiety
      Breast pain
  • Other:
    • Aching joints
    • Digestive problems
    • Gum problems
    • Tingling extremities
Investigations
  • Diagnosis normally on symptoms alone if >45yrs old
  • If <40 FSH will be raised on bloods
Management
  • HRT: combination
    • of oestrogen replacement
    • progesterone as endometrial protection
    • testosterone in some women
  • Recommended up to 50 for premature menopause, relief of symptoms
  • Dose dependent on symptoms
  • Protects against osteoporosis, reduces urinary symptoms
  • S/E: estrogenic and progestogenic, increased risk of breast cancer
Complications
  • Osteoporosis (BMD >2.5 SD from young adult mean)
  • Cyclic vomiting syndrome
  • CNS symptoms

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