Psychological symptoms, such as poor
concentration, tearfulness, loss of inter-
est in sex, and depression, are also
often attributed to the menopause.
Changes in metabolism occur during the
menopause but may not cause symp-
toms until later. Bones become thinner,
and osteoporosismay develop. There is
also an increased level of fats in the
blood, which may cause an increase in
atherosclerosisand a higher incidence
of coronary artery diseaseand stroke.
Hormone replacement therapy (HRT)
may relieve menopausal symptoms.
HRT reduces the risk of fractures associ-
ated with osteoporosis. However, it has
been associated with a slightly in-
creased risk of breast cancer. For most
women, treatment is recommended for
a duration of around 10 years.
menorrhagiaExcessive loss of blood
during menstruation. Menorrhagia may
be caused by an imbalance of oestrogen
hormonesand progesterone hormone,
which control menstruation. The imbal-
ance causes an excessive build-up of
endometrium(lining of the uterus). Dis-
orders that affect the uterus, such as
fibroids, polyps, or a pelvic infection, can
also cause menorrhagia.
Treatment may include nonsteroidal
anti-inflammatory drugs, drugs that affect
blood clotting, hormones, or the fitting
of an IUD (intrauterine device) that
releases small amounts of progestogen.
Menorrhagia may also be treated by
endometrial ablation.
menotrophinA gonadotrophin hormone
given as a drug to stimulate cell activity
in the ovariesand testes. It is used as a
treatment for certain types of male and
female infertility, as it prepares the
ovary for ovulation and may help stimu-
late sperm production. It is used along
with human chorionic gonadotrophin
(see gonadotrophin, human chorionic).
In women, menotrophin may cause
multiple pregnancy, abdominal pain,
bloating, and weight gain. In men, it
may cause enlargement of the breasts.
menstruationThe periodic shedding of
endometrium, accompanied by bleed-
ing, that occurs in women who are not
pregnant. It usually begins at puberty
and continues until the menopause.Menstruation occurs at the end of the
menstrual cycle, which usually lasts for
28 days (the normal range is 21–35 days).
At the beginning of the cycle, a hormone
from the pituitary glandstimulates an
egg folliclein an ovaryto mature. The
follicle secretes oestrogen hormones,
which make the endometrium thicken.
Ovulation(release of an egg from the
follicle) usually occurs in the middle of
the menstrual cycle. The empty follicle
also produces progesterone hormone,
which makes the endometrium become
swollen and thick with retained fluid.
This enables a fertilized egg to implant
in the endometrium. If pregnancy fails
to occur, the production of oestrogens
and progesterone diminishes. The endo-
metrium is then shed about 14 days
after ovulation. Uterine contractions
force the menstrual discharge to be
expelled into the vagina, accompanied
by bleeding, which may last for 1–8 days.
menstruation, disorders ofAn abnor-
mality in the monthly cycle of menstrual
bleeding. Menstrual disorders may be a
sign of a problem in the pelvic area,
such as fibroids, endometriosis, or pelvic
inflammatory disease, but the cause is
often unknown.
Dysmenorrhoea(painful periods) is the
most common type of menstrual disor-
der. Other types of menstrual disorder
are amenorrhoea(absence of menstrua-
tion), polymenorrhoea (too frequent
menstruation), oligomenorrhoea (infre-
quent periods or scanty blood loss),
and menorrhagia (excessive bleeding).
Some women have extreme variations
in the length of menstrual cycles or
menstrual periods, or in the amount of
blood lost (see menstruation, irregular).
menstruation, irregularA variation
in the normal pattern of menstruation.
Irregular menstruation can include vari-
ations in the interval between periods,
in the duration of menstrual bleeding,
or in the amount of blood that is lost.
The most common cause of irregular
menstruation is a disturbed balance of
oestrogen hormonesand progesterone
hormone. Other causes include stress,
travel, a change in the method of con-
traception, unsuspected pregnancy, or
early miscarriage.MENORRHAGIA MENSTRUATION, IRREGULARM