By Dr Kihara

Definition: is the cessation of the menstrual

period. It heralds the transition from
reproductive capability to incapability.
The premenopausal period to the
postmenopausal period is termed as
CLIMACTERIC and can last up to 15 years.

Causes of menopause
1. Physiological ageing of the ovaries
2. Pathologically induced menopause
Premature ovarian failure
Radiation
Cytotoxic therapy
Bilateral oophorectomy

Physiology of menopause
Hypothalamic pituitary ovarian axis
elaborated.
With the aging of the ovaries there is reduction
in the production of the sex steroids
principally estrogen and the following occurs:

1. Menstrual irregularities due to anovulation.

2. Changes in the circulating levels of sex

steroids, inhibin and pituitary gonadotrophins.

3. Decrease in the fertility rates.
4. Neuroendocrine changes of thermoregulation,
sleep patterns, mood and behavior (vasomotor
effects).
5. Eventually the cessation of menstruation and
the clinical effects of dwindling sex steroids.

Clinical picture of the climacteric

Problems associated with estrogen deficiency

Stage I
Changes in the menstrual cycle
Hot flushes
Night sweats
Insomnia
Depression
Mood changes

Stage II Intermediate
Urogenital atrophy
Dyspareunia ( painful/ difficult sexual
intercourse)
Dysuria (painful/ difficult urination)
Stress incontinence
Skin changes

Stage III Late

Osteoporosis
Cardiovascular disease
Alzheimer's disease

Management
History
Physical examination
Baseline investigations
Diagnosis
Treatment The essence of a womans vitality

and wellness must be maintained.

Ensure that you r/o malignancies

1. Relieve early symptoms.

2. Reduce intermediate and long term

consequences.
3. Enhance vitality and quality of life.

Options to treatment
1. Reassurance
2. Hormonal replacement therapy

This should be guided by the presence of the

uterus +/- cyclical bleeding, Absence of the
uterus and the ovaries
3. Presence of sexual dysfunctions and
treatment
4. Adjuvant therapy Nutrition, vitamin
supplements and herbal therapy, exercise
5.Support from partner, the family members and
community.