MENOPAUSE

The cessation of menses – the last menstrual period. In the UK menopause occurs generally at 51–52 years, following primary ovarian failure. A marker of the latter is increased production of follicle-stimulating hormone (FSH) and luteinising hormone (LH). Menopause is diagnosed after 12 months of spontaneous amenorrhoea in women ≥50 years, after 24 months in women <50 years. In either case, hormones may need to be checked before contraception is stopped.

Postmenopausal women are at increased risk of CVD, breast cancer and osteoporosis. Symptoms, if present, are caused by reduced oestrogen levels and may be:

• Vasomotor: hot flushes.
• Urogenital: atrophy of the vaginal, urethra and bladder trigone may follow reduction/absence of oestrogen and result in dyspareunia and bleeding, increased risk of infection, urinary frequency and urgency of micturition, nocturia and dysuria. Vaginal dryness is a common unspoken problem that can make it difficult to insert a speculum for cervical cytology, and also may cause soreness and stress during sexual intercourse. The PN may take the opportunity at any appropriate time to offer information, advice and support, verbally or via literature/websites.
• Psychological: irritability, lethargy, memory loss, loss of libido, depression.

Symptom management

Menopausal symptoms may last for 2–5 years or for many years.

• Hormone replacement therapy (HRT) is not entirely risk free, but is the most effective means of relieving menopausal symptoms and preventing osteoporosis; in certain age groups it may protect against heart disease.
• Women may prefer to use non-hormonal preparations to alleviate symptoms, but there is little evidence in support of their efficacy.