Menopause is the end of menstruation and fertility occurring 12 months after the final menstrual period(FMP) . It is the most symptomatic phase for women. It begins with variation in the menstrual cycle length of >7 days associated with a rise in follicle-stimulating hormone (FSH) and ends 1 year after the FMP. Symptoms usually can be Vasomotor like hot flushes or psychological with trouble sleeping, sexual discomfort, vaginal dryness and difficulties with sexual function.Somatic complaints are quite common as well.Feelings of upset, loss of control, irritability, fatigue, and dysphoria may be caused by fluctuating hormone levels that perturb neural systems transiently.
Hot flashes are a common complaint in up to 75% of peri menopausal women with highest occurrence during peri menopause and first 2 years of post menopause .It can be severe in 10%-15% of women and often abate after 3-5 years; this can be however, unpredictable and rarely some persist for a lifetime . It is more severe in smokers.
Use of HRT is mired in controversy , however, myths need to be shattered and quality of life is much more important than listening to old wives tales.A detailed discussion on the benefits, risks, contraindications and options available is required and the treatment needs to be tapered to the individual.
A variety of options are available and different routes are available. Surveillance is necessary and monitoring is also required. Tapering of medication is attempted every 6-9 months to check for cessation of treatment.