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.
CHANGES AT THE TIME OF MENOPAUSE-
Physiological Changes at
Progressive atrophy of genital
organs occur with more and more deposition of fibrous tissue
Ovaries - Shrink in size and
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
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.
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.
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.
MANAGAMENT & TREATMENT-
Treatment is broadly classified
in two categories :
-Supplementary calcium in diet
hypnotics should be used to allay psychological symptoms
-Assurance and proper advice.
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.
1) History of Breast Cancer.
2) Presence of Thrombophlebitis.
3) History of Entometrial cancer.
4) Acute liver disease.
Monitoring prior to and
(Annual checkup is mandatory)
1) B.P. recording.
2) Pelvic examination.
3) Cervical cytology.
4) Breast palpation and Mammography.
Useful remedy for climacteric
troubles with palpitation , flushes of heat, haemorrhages,
throbbing headache at the vertex with hammering pains, fainting
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
Women have the aversion to marry.
The patient crawls on floor, hides, laughs or is angry.
Predicts the future correctly. Religiousness.
Preeminently a woman remedy
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.
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.
Good remedy for climacteric
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.
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.
Nervous females thin, emaciated
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
Leucorrhoea instead of menses.
Nervous, frightened and depressed.
Does not care if she dies or lives.
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.
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
Haemorrhagic tendencies at climacteric with red flow and dark
clots, not profuse but continous.
Prostration and fainting from haemorrhage.
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
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.
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