The permanent cessation of menstruation, characterised by at least 12 months of amenorrhoea in otherwise healthy women over the age of 45 who are not using hormonal contraception

Aetiology

• Average age in UK of menopause is ~51 years
• Premature ovarian insufficiency (POI): <40 years (1%)
• Early menopause: 40-44 years (5%)

Clinical features

• Vasomotor symptoms: hot flushes, night sweats
• Sexual dysfunction: vaginal dryness, reduced libido, problems with orgasm, dyspareunia
• Psychological symptoms: depression, anxiety, mood swings, lethargy, reduced concentration
• Symptoms most severe in late peri- and early post menopause
• Most symptoms improve with time except genitourinary problems

Investigations

• Pregnancy test: indicated in sexually active women with amenorrhoea
• FSH: levels 2 x (6 weeks apart) indicated:
  • In women > 45 with atypical symptoms
  • In women between 40 and 45 with menopausal symptoms and/or iatrogenic amenorrhoea (TAH, endometrial ablation etc.)
• FSH, E2, TFT, glucose, prolactin and FAI should be checked:
  • In women < 40
  • Check also chromosomes and exclude autoimmune disorders in women <35

Management

Lifestyle

• Healthy diet
• Healthy weight
• Regular exercise