Menopause is the permanent cessation of menstruation resulting from the loss of ovarian and follicular activity. It usually occurs when women reach their early 50s. Vasomotor symptoms and vaginal dryness are frequently reported during menopause.
Estrogen is the most effective treatment for management of
hot flashes and night sweats. Local
estrogen is preferred for vulvovaginal symptoms because of its excellent therapeutic response. Bone mineral density screening should be performed in all women older than 65 years, and should begin sooner in women with additional risk factors for
osteoporotic fractures. Adequate intake of
calcium and
vitamin D should be encouraged for all postmenopausal women to reduce bone loss.
Coronary artery disease is the leading cause of death in women. Postmenopausal women should be counseled regarding lifestyle modification, including smoking cessation and regular physical activity. All women should receive periodic measurement of blood pressure and
lipids. Appropriate
pharmacotherapy should be initiated when indicated. Women should receive
breast cancer screening every one to two years beginning at age 40, as well as
colorectal cancer screening beginning at age 50. Women younger than 65 years who are sexually active and have a cervix should receive routine
cervical cancer screening with Papanicolaou smear. Recommended immunizations for menopausal women include an annual
influenza vaccine, a
tetanus and
diphtheria toxoid booster every 10 years, and a one-time
pneumococcal vaccine after age 65 years.