Menopause is a normal physiological condition and most women do not need treatment for the menopause. At least ten percent of women however may seek medical advice for relief of symptoms of menopause. Mild symptoms may be managed at home but more severe symptoms and associated medical conditions need attention.

Symptoms of menopause

Menopause is associated with several emotional and physical changes. There is initial menstrual irregularity followed by a complete cessation of menstruation. A slight increase in the amount of menstrual blood loss is also common. For many women missing three consecutive months of periods or an average cycle length longer than 42 days predicts impending menopause. Approximately 10% of women have an abrupt cessation of periods.

Some of the common symptoms include:-

• Hot flashes or hot flushes – this is a hallmark symptom of menopause. Hot flushes commonly affect the face, head, neck and chest, and last for a few minutes. There is a sudden rise of temperature but the discomfort is more due to inability to cool the body.
• Vaginal dryness – there is pain and irritation around the vulva and vagina, vaginal discomfort and dryness. This is often accompanied by painful intercourse and recurrent lower urinary tract infection and urinary incontinence. This is linked to low estrogen levels.
• Urinary incontinence or inability to hold in urine
• Mood changes and irritability – this may include anxiety, nervousness, memory loss, depression and difficulty in concentrating. There are additional medical and psychosocial problems like ill health, obesity, death of a partner, “empty nest syndrome” etc.
• Sleep disturbances and night sweats
• Sexual dysfunction and loss of libido - this occurs due to decline of female sex hormones. Dryness of the vagina, ageing partner with decreasing libido, loss of self-image etc. play a role in sexual dysfunction associated with menopause.
• Other changes include thinning and wrinkling of the skin, hair loss, joint and muscle pain, brittle nails etc. due to low estrogen levels.
• Reduced quality of life
• Associated medical conditions like raised risk of heart disease, osteoporosis, urogenital atrophy, redistribution of body fat with accumulation around the abdomen with age etc.

Diagnosis of menopause

Investigations are of limited value in diagnosis of menopause and it is detected clinically. Raised blood levels of FSH may provide clues to diagnosis of menopause. Women with suspected premature menopause or following a hysterectomy need assessment of FSH to detect premature ovarian failure.

Treatment of symptoms of menopause

Treatment options of menopause include hormone replacement therapy (HRT), tibolone (hormonal therapy), clonidine, vaginal lubricants and antidepressants.

• Hormone replacement therapy (HRT) is a combination of female sex hormones like estrogen and progesterone. HRT is effective in treating a number of menopausal symptoms like hot flushes and night sweats, vaginal symptoms and urinary tract infections. HRT over long term use may also reduce the risk of osteoporosis.

There are three main types of HRT – estrogen-only (for women who have had their womb and ovaries removed), combined HRT (with both estrogen and progesterone) and continuous HRT for long term use in postmenopausal women. HRT is also available as cream or gel, skin patches or implants to be applied locally. They can be taken as pills as well. HRT is associated with numerous side effects like weight gain, breast tenderness, nausea, headaches and mood changes.

• Tibolone is another hormone that is synthetic. It acts in the same way as HRT. It can be prescribed in post-menopausal women who want to end their periods. Tibolone is effective in treating menopausal symptoms such as hot flushes and night sweats and prevents osteoporosis.
• Gabapentin (900 mg/day) can reduce the number of hot flushes as well.
• Clonidine is a drug used for treatment of high blood pressure. It is used in postmenopausal women to reduce hot flushes and night sweats. Clonidine can cause unpleasant side effects including dry mouth, depression and drowsiness.
• Antidepressants are used in postmenopausal women with depression. Some of them may be effective in reducing hot flushes. These include SSRIs like venlafaxine, fluoxetine, citalopram and paroxetine.
• Vaginal lubricants are useful in women with vaginal dryness. These can be used long term without complications.
• Reassurance and support is needed for all women in their perimenopausal stage to prevent psychosocial problems.
• Healthy lifestyle – regular aerobic exercise can improve quality of life and symptoms such as mood swings and insomnia. A healthy diet and yoga can also help. Wearing light cotton clothing, keeping the bedroom cool at night and reduction of stress also helps keeping hot flushes at bay. Certain potential triggers such as smoking, spicy foods, caffeine and alcohol should be avoided.