The cessation of MENSTRUATION at the end of reproductive life. The average age in the UK is 51; in about 1 in 100 women it occurs before 40. The physical manifestations, as well as being unpleasant in themselves, may also be a psychologically disturbing experience. Symptoms include hot flushes, tiredness, irritability, lack of concentration, palpitations, aching joints and vaginal irritation. There may also be loss of libido (sex drive) but most women can and do live happy, active lives through the menopause, the length of which varies considerably.
One of the major problems of the menopause which does not give rise to symptoms until many years later is osteoporosis (see BONE, DISORDERS OF). After the menopause, 1 per cent of the bone is progressively lost per annum, and this is a factor in the frequency of fractures of the femur in elderly women as a result of osteoporosis. It can be prevented by hormone replacement therapy (see below).
This term has become synonymous with the scientifically correct term ‘oestrogen replacement therapy’ to signify treatment of menopausal symptoms and signs with OESTROGEN, and PROGESTOGEN (oestrogen alone to women without a uterus).
HRT is recommended for short-term use only, in menopausal women whose lives are inconvenienced by vasomotor instability (severe flushes, etc.) or vaginal atrophy, although the latter may respond to local oestrogen treatment – creams or pessaries. Oral HRT does increase the risk of venous thromboembolism but not of cardiovascular disease when started before age 60, nor does it increase the risk of diabetes. There is probably a small increased risk of breast cancer with oestrogen/progesterone combinations, which ceases after discontinuing HRT. Consequently it is no longer licensed for first-line treatment to prevent osteoporosis, so the risks of long-term treatment outweighs the benefits, except in those with the most severe menopausal symptoms. As the evidence stands at present, careful consideration of each woman's medical history and the severity of her menopausal symptoms is necessary in deciding what combination of drugs should be given and for how long. In general, the indications should be severe menopausal symptoms that can be controlled by the lowest dose for the shortest time. Women with breast cancer or who are at risk of this because they carry the BRCA gene should not take HRT.