MENOPAUSE

Notes

• Vasomotor symptoms: Flushes, headaches, palpitations, night sweats.
• Menstrual change: Irregular bleeding, amenorrhoea.
• Osteoporosis risk: Especially in the thin, smokers and those with a family history. These patients may benefit from bone density assessment.

Danger signs

• Post menopausal bleeding: is defined as a bleed after 6 months of amenorrhoea. Usually Contact GP for referral on to a Gynaecologist for D&C.
• Severe symptoms: Contact GP.
• High osteoprosis risk: Contact GP for assessment of suitability for HRT.

Notes for the elderly

• Osteoporosis risk: consider general advice: weight bearing exercise - Calcium and Vitainin D supplementation (or dietary advice) or refer for HRT advice.
• Vasomotor symptoms: these may be short lived, or may need referral for HRT to control.
• Vaginal dryness: If no bleeding a lubricant may help; if notContact GP

General advice

• Because of masked depression, many individuals may put down inability/interrupted sleep/change in libido/appetite alteration/ labile mood/ tearfulness to the menopause when really they may be depressed. The physiological changes may exacerbate this. Contact GP if depression is expected.
• Look for associated problems.
• Consider non-hormonal therapy NSAIDs - or refer for hormonal therapy.

Therapy

• Calcium supplement.
• Vitamin D supplement.
• Vaginal lubricants.

Dictionary

Amenorrhoea: absence or abnormal cessation of the menses.
Osteoporosis: reduction in the quantity of bone or atrophy of skeletal tissue.
Vasomotor: causing dilation or constriction of the blood vessels.

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