Menopause - related symptoms and their treatment

The menopause is a physiological event that occurs in all women who reach midlife. Symptoms shown to be associated with oestrogen deficiency after the menopause are hot flushes and night sweats, insomnia and vaginal dryness. However, many other symptoms and conditions (irregular menstrual bleeding, osteoporosis, arteriosclerosis, dyslipidaemia, depressed mood, irritability, headache, forgetfulness, dizziness, deterioration in postural balance, palpitations, dry eyes, dry mouth, reduced skin elasticity, restless legs, and muscle and joint pain) have also been implicated as associated with the menopause but are not necessarily correlated to oestrogen levels. Oestrogens are effective in treating vasomotor symptoms, urogenital atrophy symptoms and irregular menstrual bleeding that occurs in the perimenopausal period. Conjugated oestrogens are given orally, and oestradiol may be given orally as tablets or transdermally as a patch or gel for a period of 3 weeks or longer. Perimenopausal women and women during the first 1 to 2 years after the menopause who have an intact uterus must be treated with a gestagen for at least 12 to 14 days every month in order to prevent endometrial hyperplasia and possible endometrial cancer. With this regimen the woman will have a withdrawal bleeding every month. When the woman is 2 to 3 years postmenopausal then she can be recommended continuous administration of a fast combination of oestradiol and a gestagen that normally does not induce bleeding. Tibolone is an alternative substance (whose metabolites have both oestrogenic and gestagenic effects) that can also be used for the same indications as oestrogen preparations, the difference being that no additional gestagen is required. ✩ 18304-Ch02.qxd 12/9/05 12:46 AM Page 9