Menopause

About Menopause

Menopause is the permanent cessation of menstruation, defined as 12 consecutive months without a period. The average age of natural menopause is 51 years, with the perimenopausal transition lasting 4 to 8 years. During perimenopause, estrogen levels fluctuate dramatically before declining. Symptoms include hot flashes sudden sensation of heat spreading over the body, night sweats, vaginal dryness, mood changes irritability, depression, anxiety, sleep disturbance, cognitive changes brain fog, weight gain, and changes in hair and skin. Long term consequences of estrogen loss include osteoporosis bone loss accelerates after menopause, cardiovascular disease risk increases, and genitourinary syndrome of menopause GSM causing vaginal atrophy, urinary frequency, and recurrent UTIs. Diagnosis is usually clinical based on symptoms and age; blood tests such as FSH are mainly used in younger women or when the picture is unclear. Treatment for bothersome symptoms includes hormone therapy HT estrogen for hot flashes, bone health, and GSM. Estrogen with progestogen for women with a uterus, estrogen alone for hysterectomized women. The Women Health Initiative WHI study in 2002 dramatically reduced HT use due to reported risks, but current guidance generally considers that for many symptomatic women under 60 or within 10 years of menopause the benefits of HT outweigh the risks, with decisions individualised. Non hormonal options for hot flashes include SSRIs paroxetine Brisdelle, SNRIs venlafaxine, gabapentin, and the newer neurokinin 3 NK3 receptor antagonist fezolinetant Veozah. Vaginal estrogen treats GSM with minimal systemic absorption. Bleeding after menopause warrants medical assessment.