It is important to realize that the symptoms of
oestrogen defi ciency, loosely termed menopausal
symptoms, may begin long before the actual cessation
of menstruation, which, as noted above, defmes the
menopause itself. These symptoms are often triggered
by a relative fall in circulating E2 and hence may afflict
the patient b fo re the absolute level of circulating
E2 reaches the levels of the fully developed postmenopause
at
Physical
• Tiredness
• Hot flushes
• Night sweats
• Insomnia
• Vaginal dryness
• Urinary freQiuency
Psychological
• Mood swings
• Anxiety
• Loss of short-term memory
• Lack of concentration
• Loss of self-confidence
• Depression
Vaginal dryness is a vitally important symptom of
menopause, not least because it is frequently missed.
Some patients find it difficult to give a sexual history
and thus a gentle, courteous but full enquiry should
be made regarding the presence of dryness and asso ciated
dyspareunia. The latter can lead to significant
disharmony between partners in a relationship. The
vaginal skin is dependent on oestrogen for the depth
and lubrication of its squamous epithelium and, with
loss of plasma oestrogen, the skin becomes thin and
poorly moisturized.
The physical symptoms of menopause are partnered
by a set of psychological symptoms that can
be equally distressing and disabling. The degree to
which these symptoms are due to a lack of oestrogen
per se or to chronic sleep deprivation is not clear.
In addition, the perimenopausal years are often
marked by life events such as divorce, departure of
children, death of partner or parents and other stressful
occurrences that may contribute to the overall
psychological picture. Intrinsic personality type may
also exert an influence, with the symptoms being
more marked among those with a tendency to anxiety
and low self-esteem. There does not, however, appear
to be a true increase in formal psychiatric disorders
at this time.
Overall, it should be stressed that the severity,
duration and nature of menopausal symptoms are
highly variable. Symptoms may be absent, they may
be fleeting and mild, or they may be severe and continue
for years. The duty of the clinician is to assess
the global effect of the symptom complex presented
and to decide whether or not an exogenous replacement
of the lost oestrogen is likely to result in a
significant reduction in the symptom load.
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