Common Problems of the Menopause

Abstract

InnovAiT has previously published an article covering the physiological and clinical effects of the menopause and the indications and implications of HRT (Peet, 2009). This article will look at common menopausal problems presented to GPs and their management. This is an important topic as 80% of women experience menopausal symptoms, with 45% of them fi nding these symptoms distressing [ Royal College of Physicians of Edinburgh (RCPE, 2003) ]. In the Western societies, the commonest symptoms are hot fl ushes, night sweats, sleep disturbance and vaginal dryness. Menopausal symptoms are usually self-limiting lasting on average 2-5 years. However, some women can experience symptoms for many years. Hot fl ushes and night sweats Hot fl ushes and night sweats (the night time manifestation of a hot fl ush) affect 70-80% of perimenopausal women. They are thought to be caused by the effects of reduced oestrogen levels on the thermoregulatory nucleus in the hypothalamus, although the exact mechanism is still not fully understood. Hot fl ushes result in a sudden feeling of heat, generally in the face, neck and chest, and are often associated with fl ushing, sweating and palpitations. Hot fl ushes usually last 3-5 minutes. Vasomotor symptoms are variable in frequency, duration and severity. For 20% of women , they can be severe, causing signifi cant impact on quality of life. Hot fl ushes are most common in the fi rst year The GP curriculum and menopause GP curriculum statement 10.1: Women ' s health requires GPs to have knowledge of; Menopause and menopausal problems Mental health issues including anxiety, depression, suicide and the relationship between these and the menopause Menopause management including hormone replacement therapy (HRT) Case study 1 Elizabeth is a 52-year-old woman. She last had a period 6 months ago and is having signifi cant problems with hot fl ushes and night sweats. These occur frequently throughout the day and night. She fi nds the hot fl ushes embarrassing and disruptive at work. She is waking four to fi ve times per night with drenching sweats. As a result of her disturbed sleep, she feels exhausted and irritable and often fi nds it diffi cult to concentrate at work. She is a head teacher and her job can be very stressful at times. She has found that she often needs to drink up to six cups of coffee throughout the day at work to stay alert. She is fi nding the symptoms unbearable and is keen to try something to help them. She is not keen on the idea of HRT, remembering media coverage of concerns regarding safety. Sleep disturbance is another common symptom of the menopause and is often due to night sweats. Chronic sleep disturbance can lead to tiredness, fatigue and irritability, as well as problems with concentration and short-term memory. Controlling night sweats can improve sleep, as can maintaining a regular bedtime and avoiding exercise late in the day. Box 1 shows the management options for vasomotor symptoms. after the last period and are usually present for less than 5 years, although fo...

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