66 - Diagnosis

Diagnosis

Drug treatment of psychiatric symptoms in the context of other conditions CHAPTER 10 Menopause The menopause transition is a phase in a woman’s reproductive life where ovarian function declines, menstruation stops and production of the female reproductive hormones oestrogen, progesterone and testosterone significantly declines. The menopause signifies a date in time 12 months after a women’s last menstrual period (LMP). The normal age range for the menopause is 45–55 years. The perimenopause is the phase leading up to a women’s LMP characterised by erratic ovarian function and fluctuations in hormones. Perimenopausal symptoms typically arise 2–7 years prior to the LMP. About 75% of women experience menopausal symptoms (Table 10.20), 25% of women experience severe menopausal symptoms and 20% of women experience life-­ long symptoms.1,2 Symptoms associated with the menopause should be considered in women older than 40. However, women may experience an early menopause before 45 years of age, or premature ovarian insufficiency (POI) below 40 years of age, so symptoms may present earlier. Diagnosis Clinical diagnosis using the Greene Climacteric questionnaire is sufficient in most women older than 40 years presenting with typical symptoms. In women younger than 45 years, two raised follicle-­stimulating hormone (FSH) levels >30mIU/mL, taken 6 weeks apart, tested on days 2–5 of the menstrual cycle may help confirm a diagnosis if clinical symptoms are not conclusive.1,3 Table 10.20  Menopause symptoms. Vasomotor Physical Genitourinary Psychological Hot flushes/flashes Sleep disturbance Urinary frequency Anxiety Night sweats Muscular aches and pains Nocturia Low mood Excessive sweating Period changes – flow, duration, frequency Vaginal dryness/irritation Loss of motivation Cold chills Headaches/migraines Weight gain Tinnitus Breast tenderness Heart palpitations Acne Fatigue and low energy Vulval itching and irritation Frequent UTIs Low libido Loss of sexual pleasure Vaginal discomfort Mood swings Tearfulness Increased PMS Poor concentration and focus Brain fog Poor word-­finding and short-­term memory Irritability PMS, premenstrual syndrome; UTIs, urinary tract infections.