7 - Vasomotor symptoms, urogenital and sexual problems

Summary

Vasomotor symptoms

Hot flushes and night sweats are the most common symptoms of the menopause and these affect about 70% of Western women. Night sweats can also cause profound sleep disturbance leading to tiredness and irritability. They may begin before periods stop and usually are present for less than 5 years. Some women, however, will continue to flush into their 60s and 70s. Flushes are episodes of inappropriate heat loss mediated by cutaneous vasodilation over the upper trunk. Some women also complain of psychological symptoms such as tiredness, depressed mood, loss of libido and lethargy. Cultural differences in attitudes to the menopause seem to exist: for example, menopausal complaints are fewer in Japanese than in North American women. The effect of exercise on hot flushes is conflicting with some studies showing benefit and others not. Women with a higher level of education seem to have fewer symptoms.

Investigations

FOLLICLE-STIMULATING HORMONE

FSH levels are helpful only if the diagnosis of ovarian failure is in doubt and the levels are reported in the menopausal range (greater than 30 iu/l). FSH needs to be measured in women with suspected premature ovarian failure, whether or not they have had a hysterectomy. It is best to take samples on days 3—5 of the cycle (day 1 is the first day of menstruation). Where this is not possible — such as in women with oligomenorrhoea or amenorrhoea or who have undergone hysterectomy — two samples separated by an interval of 2 weeks should be obtained.