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Menopause - general information

Dr Piotr Bodzek, MD

You can read this text in 3 min.

Menopause - general information

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Tired woman

Basic information on the hormonal aspect of menopause is presented. The author recalls the most important fall symptoms and the rules for calculating the menopause index.

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Table of contents:

  1. Puberty (menopause)
  2. Prolapse symptoms
  3. Kupperman climacteric index
  4. Fat and carbohydrate disturbances
  5. Atrophic symptoms in the postmenopausal period

Puberty (menopause)

By the term menopause (climacterium) we understand the somatic and psychological changes associated with the process of cessation of ovarian function. According to the WHO definition, natural menopause is the last menstrual bleeding, after which menstruation no longer occurs for 12 months and no pathological causes for this condition are found. The age of menopause is around 50 years. Below 40 and above 60 years of age are considered abnormal. Underlying menopause are morphological changes in the ovaries.

At postmenopause, the ovary no longer contains follicles or granulosa cells. In perimenopause, the follicles lose their ability to reach full maturity, resulting in the corpus luteum being inefficient or not forming at all.

The main hormonal changes in perimenopause are progesterone deficiency, progressive oestrogen deficiency, increasing hypergonadotropinaemia and inhibin deficiency. Typically, there is a decrease in progesterone secretion which, in combination with hyperestrogenism, leads to endometrial proliferations and acyclic bleeding in some women.

In postmenopause, serum gonadotropin levels rise, oestradiol levels fall and oestrone becomes the predominant oestrogen (20 - 60 pg/ml in postmenopause). The main source of estrone is peripheral conversion from androstendione (adipose tissue, muscle, liver, brain, kidneys and adrenal glands). Excess estrone can cause endometrial proliferations. Its increase above 70-75 pg/ml is thought to cause uterine bleeding. Concentrations of androgens, growth hormone and kelatonin are decreased. SHBG concentration decreases slightly. The consequences of hypoestrogenism are ®ndings of prolapse, atrophy, psychoneurological symptoms and an increase in cardiovascular disease and the onset of osteoporosis. Elevated concentrations of both gonadotropins persist (10 - 15 times higher than in the reproductive period).

Accidental symptoms

  • irritability
  • fatigue,
  • depression
  • headaches,
  • heat waves,
  • memory problems,
  • weight gain,
  • sleep disturbances,
  • drenching sweats,
  • palpitations.

Kupperman climacteric index

  • Throbbing of blood to the head -> 4 pts,
  • Sweating -> 2 pts,
  • Sleep disturbances -> 2 pts,
  • Nervousness -> 2 pts,
  • Depression (depression) -> 1 pt,
  • Dizziness -> 1 pt,
  • General weakness -> 1 pt,
  • Joint pains -> 1 pt,
  • Headaches -> 1 pt,
  • Heartbeat or palpitations -> 1 pt,
  • Paresthesia -> 1 pt.

Points x multiplier = menopause index

Multiplier 0 = no complaint,

Multiplier 1 = mild symptoms,

Multiplier 2 = moderately marked symptoms,

Multiplier 3 = strongly expressed symptoms,

Fat and carbohydrate disturbances

These changes are mainly influenced by hypoestrogenism. At menopause, there is an increase in total cholesterol, an increase in LDL cholesterol (atherogenic effect), an increase in triglycerides and a slight decrease in HDL cholesterol. Dyslipidaemia associated with the menopausal period is a risk factor for cardiovascular disease. In addition, the postmenopausal period increases the incidence of hyperinsulinaemia, cellular insulin resistance and type II diabetes.

Atrophic symptoms in the postmenopausal period

Caused by oestrogen deficiency and ageing processes.

  • atrophic changes in the vagina -> atrophy of the mucous membrane in the vagina (promotes inflammation and discomfort during intercourse). Sensation of dryness, irritation, burning, itching, feeling of pushing, abundant yellow symptoms, soreness during intercourse. Treatment -> oestrogens (generally and vaginally), anti-inflammatory drugs and lubricants,
  • recurrent urethritis and cystitis,
  • frequent urination,
  • painful urination,
  • urinary incontinence.