Question

What are the clinical features and relevant physical examination to be done in a lady with menopause?

Hint:

In addition to the common menopausal symptoms, a thorough examination should include breast, pelvic, and bone health assessments.

Answer 1

Step 1: Clinical Features of Menopause.
The clinical features of menopause are primarily due to the decrease in estrogen levels. Common symptoms include:
(1) Hot Flashes and Night Sweats:
- Sudden feelings of intense warmth, typically over the face, neck, and chest, leading to sweating, especially at night.
(2) Irregular Periods:
- Menstrual cycles become unpredictable in the perimenopausal phase, with varying flow and frequency before periods stop altogether.
(3) Vaginal Dryness and Atrophy:
- Decreased estrogen levels lead to vaginal dryness, which can cause discomfort during sexual intercourse (dyspareuni and increased susceptibility to infections.
(4) Mood Changes:
- Irritability, anxiety, depression, or mood swings may occur due to hormonal fluctuations.
(5) Sleep Disturbances:
- Difficulty falling or staying asleep, often associated with night sweats or hot flashes.
(6) Decreased Libido:
- Reduced interest in sexual activity due to hormonal changes and vaginal discomfort.
(7) Urinary Symptoms:
- Increased frequency of urination, urgency, or increased risk of urinary tract infections (UTIs).
(8) Osteoporosis:
- Decreased bone mineral density due to reduced estrogen, leading to increased risk of fractures.
Step 2: Physical Examination.
A thorough physical examination should include:
(1) Vital Signs:
- Blood pressure measurement to rule out hypertension, which can become more common during menopause.
- Pulse and temperature to check for signs of underlying conditions.
(2) Abdominal Examination:
- To rule out any gynecological or gastrointestinal issues.
(3) Breast Examination:
- To check for any lumps, tenderness, or signs of breast cancer, which becomes more common as women age.
(4) Pelvic Examination:
- To assess vaginal atrophy, uterine size, and pelvic organ prolapse. It is also essential to screen for abnormal masses or uterine issues.
(5) Bone Health Assessment:
- A DEXA (dual-energy X-ray absorptiometry) scan may be considered to assess bone mineral density and screen for osteoporosis.