Makindo Medical Notes

🌸 Menopause marks the end of reproductive life. It is defined as the permanent cessation of menstruation for 12 consecutive months, typically between ages 45–55. The transition leading up to this, called perimenopause, often begins several years earlier.

🌀 Stages of Menopause

• Perimenopause: Lasts 4–8 years. Irregular cycles, hot flashes, night sweats.
• Menopause: No menses for 12 months. Ovarian follicular activity ceases → ↓ estrogen + ↓ progesterone.
• Postmenopause: Life-long phase after menopause. Persistently low estrogen, no menstruation.

⚙️ Physiological Changes

• Hormonal: ↓ Estrogen & progesterone → ↑ FSH & LH due to loss of feedback.
• Reproductive tract: Ovarian, uterine, and vaginal atrophy; dryness & discomfort.
• Bone: Accelerated bone loss → osteoporosis risk.
• Cardiovascular: Lipid profile changes → higher risk of IHD, stroke.
• Metabolic: ↓ BMR → weight gain, increased central adiposity.

🌡️ Symptoms

• Vasomotor: Hot flashes, night sweats.
• Genitourinary: Vaginal dryness, dyspareunia, ↑ UTIs, incontinence.
• Psychological: Mood swings, anxiety, poor concentration, depression.
• Other: Insomnia, fatigue, joint pain, skin thinning, hair changes.

🩺 Management

• Lifestyle: Exercise, calcium + vitamin D, healthy weight, avoid hot flash triggers (spicy food, alcohol, caffeine). Mind–body therapy (yoga, CBT, mindfulness).
• HRT (Hormone Replacement Therapy): Gold standard for vasomotor & genitourinary symptoms. Various forms (oral, patch, gel, vaginal). Must weigh risks (VTE, breast Ca) vs benefits.
• Non-Hormonal: SSRIs/SNRIs for hot flashes, bisphosphonates & SERMs for bone, vaginal lubricants/moisturizers.
• Complementary: Soy, phytoestrogens, herbal remedies (black cohosh, red clover) — mixed evidence, use with caution.

📌 Clinical Significance

• Osteoporosis: Monitor BMD, consider DXA scans, prophylaxis with bisphosphonates in high risk.
• Cardiovascular disease: Risk rises postmenopause. Emphasise prevention (lipid control, BP, lifestyle).
• Quality of life: Symptom control + reassurance can greatly improve well-being.

✅ Menopause is a natural stage but often symptomatic. With patient-centred care — from reassurance and lifestyle guidance to HRT when indicated — clinicians can help women maintain health, independence, and quality of life.

Cases — Menopause

• Case 1 — Typical vasomotor symptoms 🔥: A 52-year-old woman presents with hot flushes, night sweats, poor sleep, and mood swings. Periods stopped 14 months ago. Exam: normal. Diagnosis: natural menopause with vasomotor symptoms. Managed with lifestyle advice and HRT after discussing risks and benefits.
• Case 2 — Premature ovarian insufficiency (POI) ⏳: A 36-year-old woman reports secondary amenorrhoea for 9 months, hot flushes, and vaginal dryness. Bloods (×2, 6 weeks apart): FSH persistently >40 IU/L, low estradiol. Diagnosis: premature menopause. Managed with HRT (or COCP) until average menopausal age to protect bone and cardiovascular health.
• Case 3 — Postmenopausal bleeding 🚨: A 61-year-old woman presents with vaginal bleeding 8 years after her menopause. Exam: atrophic vaginal mucosa, but urgent referral made. Transvaginal ultrasound: endometrial thickness 7 mm. Diagnosis: postmenopausal bleeding — endometrial cancer until proven otherwise. Managed with urgent hysteroscopy and biopsy.

Teaching Point 🩺: Menopause = permanent cessation of menstruation due to ovarian follicle depletion (average age UK ~51). - Common symptoms: hot flushes, sweats, sleep/mood changes, vaginal dryness, reduced libido. - Premature menopause (<40 years) → higher risk of osteoporosis & CVD, requires HRT. - Postmenopausal bleeding is always abnormal → urgent 2-week referral.