MENOPAUSE
From adolescence to menopause, follow-up is essential.
It provides contraception, replacement therapy and cancer screening.
Clinical menopause is recognised after 12 months of amenorrhea, the lack of menstrual bleeding.
The average age of menopause is 51 years in most women. However, there is considerable variability around the onset of menopause with 5 percent of women undergoing menopause after age 55 and another 5 percent between ages 40 and 45 years.
In the early menopausal transition, women begin to experience some menstrual irregularity and later on, during the late menopausal transition, cycle variability increases.
In many the cases the irregular bleeding is already accompanied by hot flushes.
Once the menopause has begun, most women feel vaginal dryness, sleeping disorder and mood swings.
Hot flushes typically begin as the sudden sensation of heat centered on the upper chest and face that rapidly becomes generalised.
The sensation of heat lasts from two to four minutes, is often associated with profuse perspiration and occasionally palpitations, and is sometimes followed by chills, shivering, and a feeling of anxiety.
When hot flushes occur at night, women typically describe them as “night sweats” that can cause significant sleep disturbances.
Menopause itself cannot be treated, only its symptoms can be.
The most effective treatment available for relief of menopausal symptoms is oestrogen combined with a progestin. It is highly effective for the management of hot flushes, vaginal atrophy and, in some cases, the mood lability that many women experience during the menopausal transition. In addition, it helps to prevent osteoporosis.
Your choice should be guided by a gynaecologist after evaluating your risk / benefit ratio.
The most effective and the least dangerous treatment is low-dose transdermal oestrogen combined with continuous progesterone.
Environmental and behavioural changes can be efficient in dealing with hot flushes such as weight loss and regular physical exercise.
Soy products and herbal therapies (in particular, black cohosh) are commonly used by postmenopausal women, but their efficacy has not been established, in other words, they did not prove to be more efficient than placebo.
Other complementary therapies that have been studied with inconsistent results include acupuncture, mind-body-based therapies and paced respiration, thus their efficacity has never been proven.
Although women are often concerned that taking menopausal hormone therapy will exacerbate the weight gain that occurs in midlife, no clinical evidence was found of an effect on body weight or body mass index
Any bleeding after the menopause should be investigated by a specialist in a very short delay.