Common gynaecological problems in post menopausal women

Menopause is a period after cessation of menstruation. Postmenopausal women tend to have some specific problems of menopause as well as other issues that may be more pronounced after menopause.

The symptoms of menopause can be disturbing to the woman. This can include symptoms of hot flashes, excessive sweating, vaginal dryness mood disturbance, and insomnia. The long-term problem of menopause such as osteoporosis is a significant problem in elderly women that can lead to fractures. A healthy lifestyle and the possibility of hormone replacement therapy need to be considered to have a healthy postmenopausal life.

Vaginal discharge is a common problem in postmenopausal women. The hormonal changes of menopause cause changes in the vaginal flora equilibrium. This may be associated with an increase in variety of vaginal infections.

The problems of uterovaginal prolapse and urinary incontinence can be debilitating to some women. Prolapse can include uterine prolapse, bladder or rectal prolapse (cystocele, rectocele), or vault prolapse for women after hysterectomy. Stress incontinence also has similar risk factors. Treatment options include pelvic floor exercise (PFE) for early-stage prolapse. The vaginal support pessary is useful for immediate relief of prolapse, in women who are not keen or fit for surgery. Different options of surgery can be carried out for women who are keen on surgery. Surgical options such as vaginal slings can be considered for women with stress incontinence where the PFE is not effective.

Postmenopausal bleeding can be a distressing symptom and bring anxiety to the women. A possible cause could be due to severe vaginal atrophy. This can be addressed with vaginal moisturizers or estrogen local application. The more significant problem could be associated with cervical cancer or endometrial cancer. Pelvic examination and ultrasound of the pelvis can help in the correct diagnosis. 

Ovarian tumours can also be seen in postmenopausal women. Unfortunately, the symptoms can be vague and therefore cause late presentation. Early diagnosis can ensure a better prognosis.