Menopause refers to the permanent cessation of menstruation due to loss of ovarian function. The clinical diagnosis is confirmed when amenorrhea persists for 12 consecutive months without any other pathological cause.
- Age of onset: 45–55 years (Average: 50 years)
Hormonal Changes
- Gonadotropins: Increased GnRH, FSH, LH
- Estrogen: Decreased estradiol levels
- Androgen levels: Increased due to reduced estrogen metabolism
Morphological Changes
Genital Changes
· Vagina:
- Vaginal epithelium becomes thin, rugae absent
- Loss of elasticity
- Scanty cervical secretions
- Alkaline vaginal pH
- Loss of Lactobacillus → Increased infection risk
· Uterus:
- Endometrial atrophy
- Reduced blood supply
- Uterine shrinkage and descent
· Ovaries & Fallopian Tubes:
- Reduced ovarian size
- Fallopian tubes become thinner
· External Genitalia:
- Labia become flattened
- Pubic hair becomes scanty
Systemic Changes
· Breasts:
- Glandular atrophy
- Nipple size decreases
- Fat accumulation → Pendulous breasts
· Bladder & Urethra:
- Thinning of epithelium → Increased risk of urinary infections
- Loss of muscle tone
· Pelvic Floor Muscles & Connective Tissue:
- Weak pelvic ligaments → Uterine prolapse risk
- Scanty pelvic cellular tissue
Symptoms of Menopause
1. Vasomotor Symptoms
- Hot flashes (Sudden sensation of heat, flushing)
- Night sweats
- Palpitations
2. Urogenital Symptoms
- Vaginal dryness & atrophy
- Pain during intercourse (Dyspareunia)
- Increased risk of urinary tract infections
- Urinary frequency and urgency
3. Psychological Changes
- Mood swings
- Depression & irritability
- Insomnia & fatigue
- Difficulty concentrating
4. Osteoporosis & Musculoskeletal Effects
- Decreased bone density → Increased fracture risk
- Joint pain and stiffness
5. Cardiovascular Changes
- Increased risk of cardiovascular diseases
- Loss of estrogen’s protective effect on blood vessels
Treatment & Management
1. Non-Hormonal Therapy
· Lifestyle modifications:
- Exercise (Walking, jogging, yoga)
- Healthy diet (Rich in calcium & vitamin D)
- Avoid smoking & alcohol
· Medications:
- Calcium & Vitamin D supplements
- Bisphosphonates (For osteoporosis prevention)
- Clonidine (For vasomotor symptoms)
- Selective Estrogen Receptor Modulators (SERMs)
2. Hormone Replacement Therapy (HRT)
- Estrogen Therapy: Oral, transdermal, vaginal
- Combined Estrogen-Progesterone Therapy
- Progesterone Therapy: To prevent endometrial hyperplasia
3. Surgical Menopause Management
- Indicated for premature or surgically induced menopause
- HRT required if ovaries are removed before natural menopause
Flowchart of Menopause
Menopause (Cessation of Menstruation for 12 months)
↓
Hormonal Changes
- ↑ FSH, LH
- ↓ Estrogen
& Progesterone
↓
Physical & Psychological Changes - Hot flashes, night sweats
- Vaginal atrophy, dryness
- Osteoporosis, joint pain
- Depression, mood swings
↓
Management - Lifestyle Changes (Exercise, Diet, Supplements)
- Non-Hormonal Therapy (Bisphosphonates, Clonidine, SERMs)
- Hormone Replacement Therapy (Estrogen, Progesterone)
Keynote Symptoms of Menopause
- Hot flashes & night sweats
- Mood swings, irritability, and depression
- Vaginal dryness & painful intercourse
- Bone loss (Osteoporosis) & joint pain
- Increased risk of cardiovascular diseases
1. Lachesis
Indications:
- Hot flashes with intense heat and sweating
- Palpitations and intolerance to tight clothing
Keynote Symptoms:
- Left-sided complaints worsen during menopause.
- Sensation of constriction, especially around the neck.
- Extreme talkativeness and jealousy.
- Symptoms worsen after sleep.
- Hot flashes with a feeling of suffocation.
2. Sepia
Indications:
- Extreme fatigue and mental exhaustion
- Vaginal dryness and loss of libido
Keynote Symptoms:
- Feels indifferent towards loved ones.
- Bearing down sensation in the pelvis.
- Aversion to sex due to vaginal dryness.
- Worse in cold weather, better with vigorous exercise.
- Brownish discoloration of the face (chloasma).
3. Calcarea Carbonica
Indications:
- Excessive weight gain and cold intolerance
- Weak bones and osteoporosis during menopause
Keynote Symptoms:
- Profuse sweating, especially on the head.
- Weakness, fatigue, and sluggish metabolism.
- Anxiety with a fear of impending disaster.
- Craving for eggs and indigestible things.
- Cold, clammy hands and feet.
4. Pulsatilla
Indications:
- Mood swings, depression, and weepiness
- Irregular and delayed menopause with erratic bleeding
Keynote Symptoms:
- Symptoms constantly changing and unpredictable.
- Seeks comfort and reassurance.
- Worse in warm rooms, better in open air.
- Prefers mild, gentle handling of emotions.
- Craves fatty foods but dislikes warm drinks.
5. Sulphur
Indications:
- Hot flashes with burning sensation in soles and palms
- Irritable and restless nature with aversion to bathing
Keynote Symptoms:
- Sensation of heat in the body, especially feet.
- Dry, rough, and itchy skin.
- Worsening of symptoms after bathing.
- Intellectual but careless in appearance.
- Strong craving for sweets and spicy food.
