The menopause literally means the last menstrual period. The
climacteric, which is commonly referrred to as the menopause, is
the time period in which symptoms occur, oestrogen production
falls and ultimately ceases.
The menopause usually occurs between 48 and 52 years of age
(the average in the UK is 50 years).
Symptoms include hot flushes, sweats, psychological disturbances
(such as memory loss, concentration failure, depression and loss
of libido), vaginal dryness, loss of bone density
(osteoporosis), loss of breast tissue, skin thinning, discomfort
during sexual intercourse, and urinary frequency and urgency.
Irregular menstrual disturbances or sudden loss of
menstruation may also occur.
The symptoms can be treated with hormone replacement therapy
(HRT). This may be either a combination of oestrogen and
progesterone, or oestrogen alone if the patient has had a
hysterectomy. HRT may be given as tablets, patches, gels,
implants or local vaginal preparations.
With most HRT drugs, menstruation will continue until the woman
stops taking the drug, but there are drugs that provide
hormone replacement without causing bleeding.
Patches may be used to provide hormone replacement therapy
(HRT). Patches have the advantages that they give a more
constant dose of hormone and require changing only once or twice
a week.
Patches may contain either a combination of oestrogen and
progesterone, or oestrogen alone. If the uterus is still
intact, a combination of oestrogen and progesterone is
given, or an oestrogen-only patch with progesterone tablets for
2 weeks of the month. If the woman has previously undergone a
hysterectomy, oestrogen is given alone.
The patch is usually positioned on the lower body or
thigh. It will need to be changed twice a week, but should
not come off in the bath or when swimming.
Irritation may occur, but this can be minimized if the patch is
left open to the air for 1-2 minutes before being applied.
Implants may be used to provide hormone replacement therapy
(HRT). Implants have the advantages that they give a more
constant dose of hormone and need to be replaced only once every
6 months.
Implants may contain oestrogen alone or a combination of
oestrogen and testosterone. Testosterone is given if the woman
is suffering loss of libido. Progesterone cannot be given as an
implant and, if it is needed, must be given as tablets.
Insertion of the implant is carried out under a local
anaesthetic and takes about 5 minutes. The implant is inserted
through a small incision about 1 centimetre long. The incision
is then sometimes stitched at the end.
Once in place, the implant cannot be removed, but will need
to be replaced every 6 months.
Usually, implants do not cause any problems and cannot be
felt under the skin. Occasionally, however, an implant may
be rejected and need to be reinserted.
