1. Introduction:

• The menopause refers to the time of cessation of periods (menstruation) 47-52 yrs. The cause is failure of the ovary to produce hormones & ova.
• Cessation of periods can occur suddenly or preceded by light and infrequent periods.
• FSH & LH are high (FSH of more than 20 I.U/L is diagnostic of menopause).
• The most important long-term metabolic side effect of menopause are osteoporosis (decrease bone density) & cardiovascular disease.
• The consequence of osteoporosis is the high incidence of bone fractures of vertebral spine, proximal femur & lower radius.

2. Symptoms and signs of the menopause:

2.1. Vasomotor instability:

• Hot flushes.
• Night sweats.
• Palpitations.
• Headache.

All these are attributed to estrogen deficiency. 80% of women experience hot flushes at sometimes during the climacteric. Occur daily (more than 5yrs). Increased skin temp., sweating and faintness.

2.2. Atrophic changes:

• Caused by estrogen deficiency.
• Atrophy of the vulva, vagina, urethra & the uterus.
• Dyspareunia, recurrent bladder pain, urgency and frequency.
• Postmenopausal bleeding.
• Utero-vaginal prolapse & vague pelvic symptoms.
• Decrease in skin thickness.

2.3. Psychological changes:

• Depression.
• Lethargy.
• Loss of concentration.
• Irritability.
• Poor lipido.
• Insomnia.

These symptoms are merely due to estrogen deficiency

• Ischemic cardiovascular disease.

3. Management:

• As most women can live about 30yrs after the menopause every effort should be done to make this period happy, and the above mentioned problems should be relieve.
• The menopause should be treated seriously, being a state of hormone deficiency the woman should be given the chance to have replacement therapy with estrogen for here symptoms & for long-term health. Estrogen replacement therapy is very beneficial & very essential for treatment of these  women. It can be given orally, hormone implants as local applications as vaginal or skin creams.