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Symptoms of the menopause

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Numerous symptoms can be attributed to the lack of oestrogen at the time of the menopause. Some of the mechanisms for this are still unclear. However, while there is substantial evidence that many of the symptoms that women encounter during the menopausal period can be directly attributed to oestrogen deficiency, others are less well supported. An up-to-date review of the literature is provided.

Section snippets

Pathophysiology of the menopause

The menopause is defined as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity1, and it marks the end of a woman's reproductive capacity. It is a retrospective diagnosis usually made after 12 months of amenorrhoea, and may be genetically determined. Symptoms often begin in the perimenopausal years. In the UK, the mean age for the menopause is 50 years and 9 months.2 This has changed very little over the last 100 years despite a fall in the average age

Symptoms of the menopause

Many symptoms are associated with the menopause, but the two that are usually the most significant and therefore most distressing to women are the hot flush, which often leads to insomnia, and vaginal dryness. These symptoms are directly related to a decrease in oestrogen levels and are experienced by over 70% of women. Most menopausal symptoms can be classified into either physical or psychological in nature.

Treatment

HRT is acknowledged as the gold standard for the alleviation of the distressing vasomotor symptoms of the menopause. Numerous studies have compared the efficacy of various types, routes and doses of HRT on alleviating vasomotor symptoms. Most studies concluded that HRT improves vasomotor symptoms, irrespective of route or type of oestrogen or progestogen.2

However, due to the marked effect that can be observed with placebo treatment, the most useful studies are those that compare HRT with a

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