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Menopause is defined as permanent cessation (stoppage) of menstruation at the end of reproductive life due to ovarian follicular inactivity.

Climacteric is a physiological period in woman's life during which there is regression of ovarian function. This covers a wide period ranging from 5-10 years on either side of the menopause.

In practice, both these terms are used as synonyms or interchangeable.


Age of menopause: - The age at which the menopause occurs is predetermined genetically. It is not related to the age of menarche or age of last pregnancy.

It is also not related to the number of pregnancies, use of contraceptive pills.

The age of menopause ranges between 45-55 years, average being 50 years.


Physiological Changes at Menopause: -

Progressive atrophy of genital organs occur with more and more deposition of fibrous tissue in them.

Ovaries - Shrink in size and become wrinkled.

Fallopian Tubes - Shrink in size with diminished motility.

Uterus - Small and fibrotic due to atrophy of muscles. Inner lining (endometrium) becomes thin and atrophies and cervical secretion becomes scanty, thick and later on disappears.

Vagina - becomes narrower due to loss of elasticity, the rugae progressively flatten.

Vulva - shows features of atrophy and narrowing of introitus. Pubic hair becomes scanty.

Breast - The fat gets reabsorbed and the glands atrophy. Breasts become flat and pendulous. The nipples decrease in size.

Bladder and urethra - Similar changes to those of vagina.

Physical Changes: -

Loss of body weight, decrease in the cell mass of the organs, skin wrinkles and becomes less elastic. Kyphosis (bending of the spine) due to lack of calcium (osteoporosis).

Metabolic: - Osteoporosis (lack of calcium) as a result of hormone(Oestrogen) deprivation.

Digestive Changes: - The activity (motor) of the entire digestive tract diminishes resulting in dyspepsia and constipation.

Loss of Muscle tone - leads to pelvic relaxation, uterine descent and anatomic changes in the urethra and neck of the bladder. Aggravation of preexisting weakness.


Clinical Importance: - Due to the increased life expectancy, 1/3 of the life span will be spent during the period of oestrogen deprivation stage with long term symptomatic and metabolic complications.


Characteristic symptom of menopause is 'hot flush'. It lasts for 1-2 minutes, but at times it is unbearable. Frequently associated with profuse sweating, sleep disturbance at night. Probably related to low level of oestrogen. Patient experiences palpitation and tachyeardia at times.

Genital and urinary
Decreased libido and symptoms, mainly dyspareumia (difficulty in sexual intercourse) due to dryness of vagina and atrophic changes.

Urethral symptoms like urgency in urination, pain during urination, recurrent urinary and stress in continuance.

Increased frequency of anxiety, headache, insomnia, irritability and depression.

Health Hazards

Harmonal imbalance leading to osteoporosis and greater susceptibility to fractures.

There is increased chance of cardiovascular disease, this could be due to rise in lipids level (both triglycerides and Cholesterol).


1) Cessation of menstruation for 6 months consecutively.

2) Appearance of menopausal symptoms mainly hot flush and night sweats.

3) Vaginal cytology.

4) Hormone assay.


Treatment is broadly classified in two categories :




-Nutritious diet


-Supplementary calcium in diet

-Tranquilisers, sedatives, hypnotics should be used to allay psychological symptoms

-Assurance and proper advice.

Hormone Replacement Therapy (HRT)

This is basically indicated in menopausal women to overcome short term and long term consequences of oestrogen deficiency.

The main objective of HRT is to ensure potential benefits and minimise risk.

1) HRT is beneficial in symptomatic women unless there is contraindication.
2) It helps in preventing osteoporosis, athelosclerosis, cardiovascular disease, degenerative changes in the skin.

Contraindications of HRT

1) History of Breast Cancer.

2) Presence of Thrombophlebitis.

3) History of Entometrial cancer.

4) Acute liver disease.

Monitoring prior to and during HRT
(Annual checkup is mandatory)

1) B.P. recording.

2) Pelvic examination.

3) Cervical cytology.

4) Breast palpation and Mammography.


1) Lachesis-

Useful remedy for climacteric troubles with palpitation , flushes of heat, haemorrhages, throbbing headache at the vertex with hammering pains, fainting spells.
Ailments from(A/F) long lasting grief, sorrow, fright, vexation, jealosy and dissapointed love.
Cannot tolerate pressure of clothes.
Menses too short, scanty, black, lumpy, acrid, vicariousfrom nose. Pains >> flow.
Left ovary painful, swollen and indurated.
Mammae inflamed, bluish.
Nipples erect, swollen and painful to touch.
Leucorrhoea copious,staining the linen greenish and stiffening.
All symptoms << after sleep, morning on waking.
Intolerance of tight bands about neck or wrist.
Mentally nervous excitable.
Talkativeness, jumps from one topic to another.
Thinks herself under superhuman control.
Thinks herself persued, despised hated.
Jealosy and suspicion are the characteristics of the remedy.
Fears to go to sleep or lying down, fears otherwise the heart would stop.
Women have the aversion to marry.
The patient crawls on floor, hides, laughs or is angry.
Predicts the future correctly. Religiousness.

2) Sepia-

Preeminently a woman remedy during climacteric.
Woman with dark hair, rigid fibre but mild and easy disposition.
Weak dragging bearing down sensation as if everything would escape from the vulva. Griping pain in the uterus.
Must cross the limbs or hold theparts to prevent protrusion.
Menses too late and scanty, irregular, early and profuse. Leucorrhoea yellow, green, milky in large lumps, in little girls, foul with stiches up in the vagina from the uterus to the navel.
Nipples cracked.
Coition painful from dryness of the vagina, bleeding after coition. Nausea and irritability at the thought of coition.
Sudden flushes of heat, sweating and weakness.
Sensation of a ball in the inner parts with constipation.
Indifferent even to ones family, to those she loves.
Wants top commit suicide.
Constantly worries frets and cries about her immaginary illness. Weeps when telling symptoms.
Sits quitely and answers in yes or no.
Women hate men.
Breaks out in spells of weeping.

3) Graphites-

Good remedy for climacteric complaints.
Suited to women who are obese and suffer from habitual constipation.
A/F from grief and fear
Menses late, scanty, pale, irregular and painful.
Swelling hardness of the ovaries.
Hoarseness, coryza,
Swelling of the feet or headache during menses.
Leucoohoea in place of menses which is pale, thin, profuse, excoriating and in gushes << before menses.
Nipples sore cracked. Vagina dry and hot.
Coition painful and marked aversion to coition.
Eczematous eruption aroud the vulva.
Sad, fearsome indecisive,timid.
Fidgety while sitting at work.
Weeps without cause. Weeps from music.
Thinks of death and nothing else.
Remembers all events of youth but recent events are forgotten.

.4) Xanthoxyllum-

Nervous females thin, emaciated with insomnia
Occipital headache at the time of climaxes.
Menses too early, profuse, thick almost black blood.
Ovarian neuralgia with pain in the hips and lower abdomen.
Pain goes to the thighs and radiates over the whole body even the heart.
Leucorrhoea instead of menses.
Nervous, frightened and depressed.
Does not care if she dies or lives.

5) Sanguinaria-

Useful for climacteric with circumscribed redness of cheeks and abdomen, congestion of blood to head, chest and abdomen with flushes of heat and pulsations all over the body.
Burning heat.
Menses offensive and profuse. Uterine polyp.
Itching of axilla before menses.
Leucorrhoea acrid and offensive.
Breast sore and enlarged at menopause. Nipples sore.
Irritable, grumbling. Indisposed to move or make any mental effort.

6) Vipera-

A/F Menopause.
Haemorrhagic tendencies at climacteric with red flow and dark clots, not profuse but continous.
Prostration and fainting from haemorrhage.

7) Cimicifuga-

Suited to plump, delicate, sensitive, nervous,chilly women who complain of aching pain in back and neck.
A/F fear, fright, anxiety, dissapoined love and overexertion.
Menses profuse, dark offensive with backach and irregular in time.
More flow than the pain.
Pain in the ovarian region, shoots upward and downward and anterior surface of the thighs, from ovary to ovary.
Burning in the breast and pain under the breast.
Lucorrhoea with sensation of the weight in the uterus.

8) Millefolium

Uterine haemorrhages. Blood bright red fluid . Menses early, profuse and long lasting.


1) Kali Mur-

Menses too late or suppressed or too early.
Excessive discharge of dark, clotted, black blood like tar. Leucorrhoea white, milky, thick, non irritating and bland.
Ulceration of the os with the discharge.
Chronic congestion of the uterus and hypertrophy.
Second stage of inflammation is the characteristic of the remedy.

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