Menopausal complaints

What is the menopause?

The final menstrual period in a woman's life is called the menopause. The perimenopause ('the change') is 'that time of life' between when menstrual periods become more irregular until one year after the menopause. In layman's terms, the perimenopause is often simply referred to as the menopause. The postmenopause is the period beginning one year after the last menstruation.

What are the complaints associated with the menopause?

Typically, the hormonal changes during the perimenopause result in: irregular menstrual periods, and possibly more, or even less, bleeding than previously; vasomotor symptoms such as hot flushes (short, sudden and intense heat sensations, usually in the face, neck and chest, sometimes followed by perspiration), sweating (particularly at night); vaginal dryness, dyspareunia (pain during intercourse). These complaints may lead to others. Sweating at night, for example, may result in sleep disorders and therefore fatigue.

People with intellectual disabilities sometimes find it impossible to communicate these symptoms. The people around them may then notice only a change in behaviour.

How common are menopause complaints in the general population?

The age at which half of Dutch women reach the menopause is on average between 50 and 51 years (usually between 40 and 60 years). Women who smoke reach the menopause earlier on average.

Menopause symptoms, and particularly vasomotor complaints, affect 60% of women. Only a small proportion seek medical help. Morbidity records indicate that the incidence rate for menopause symptoms in general practice is approximately 17 per 1000 women annually. The prevalence of vasomotor complaints is highest during the perimenopause. The menstrual cycle changes occur (by definition) during the perimenopause. The complaints due to urogenital atrophy (dryness and soreness in the urinary tract and vagina) mainly increase during the postmenopausal period (in 15-30% depending on age). ⁴⁴⁴

How common are menopause complaints in people with intellectual disabilities?

It is not known how often women with intellectual disabilities have menopause symptoms. An interview with 15 women with intellectual disabilities showed that they knew and understood little about the menopause. This means that they will tend not to report menopause symptoms. A number of women said that they were in any case happy that they no longer menstruated. ⁴⁴⁵

Furthermore, people involved are not always alert to menopause symptoms or they may not pay particular attention to them. ⁶⁰⁹

It has been suggested that women with intellectual disabilities are more likely to reach the menopause earlier. ⁴⁴⁵ ^{,

⁴⁴⁶}^{,

⁴⁴⁷}
Studies in this area have focused on Down syndrome ⁴⁴⁸ ^{,

⁴⁴⁹}^{,

⁴⁵⁰}^{,

⁴⁵¹}and the fragile-X syndrome ⁴⁵² ^{,

⁴⁵³}^{,

⁴⁵⁴}in particular.

The average age of the menopause in women with Down syndrome was found to be 44 to 46 years. ⁴⁴⁹ ^, ⁴⁵⁰
The age at which women with Down syndrome reach the menopause is related to the age at which they develop dementia and die (earlier menopause is associated with a higher risk of earlier dementia and mortality). ⁶¹⁰

0.27% to 3% General population

Not known for people with intellectual disabilities

372

Bouma J, De Jonge M, De Laat EAT, Eekhof H, Engel HF, Groeneveld FPMJ, Stevens NTJM, Verduijn MM, Goudswaard AN, Opstelten W, De Vries CJH. NHG-Standaard De overgang (eerste herziening). Nederlands Huisartsen Genootschap, 2012.

373

Willis DS. A decade on: what have we learnt about supporting women with intellectual disabilities through the menopause? J Intellect Disabil. 2008 Mar;12(1):9-23.

579

Chou YC, Lu ZY, Pu CY. Menopause experiences and attitudes in women with intellectual disability and in their family carers. J Intellect Dev Disabil. 2013 Jun;38(2):114-23.

373

Willis DS. A decade on: what have we learnt about supporting women with intellectual disabilities through the menopause? J Intellect Disabil. 2008 Mar;12(1):9-23.

374

Carr J, Hollins S. Menopause in women with learning disabilities. J Intellect Disabil Res. 1995 Apr;39 ( Pt 2):137-9.

375

Martin DM, Kakumani S, Martin MS, Cassidy G. Learning disabilities and the menopause. J Br Menopause Soc. 2003 Mar;9(1):22-6.

376

Ejskjaer K, Uldbjerg N, Goldstein H. Menstrual profile and early menopause in women with Down syndrome aged 26-40 years. J Intellect Dev Disabil. 2006 Sep;31(3):166-71.

377

Seltzer GB, Schupf N, Wu HS. A prospective study of menopause in women with Down’s syndrome. J Intellect Disabil Res. 2001 Feb;45(Pt 1):1-7.

378

Cosgrave MP, Tyrrell J, McCarron M, Gill M, Lawlor BA. Age at onset of dementia and age of menopause in women with Down’s syndrome. J Intellect Disabil Res. 1999 Dec;43 ( Pt 6):461-5.

379

Schupf N, Zigman W, Kapell D, Lee JH, Kline J, Levin B. Early menopause in women with Down’s syndrome. J Intellect Disabil Res. 1997 Jun;41 ( Pt 3):264-7.

380

Rodriguez-Revenga L, Madrigal I, Badenas C, Xunclà M, Jiménez L, Milà M. Premature ovarian failure and fragile X female premutation carriers: no evidence for a skewed X-chromosome inactivation pattern. Menopause. 2009 Sep-Oct;16(5):944-9

381

Bussani C, Papi L, Sestini R, Baldinotti F, Bucciantini S, Bruni V, Scarselli G. Premature ovarian failure and fragile X premutation: a study on 45 women. Eur J Obstet Gynecol Reprod Biol. 2004 Feb 10;112(2):189-91.

382

Sherman SL. Premature ovarian failure in the fragile X syndrome. Am J Med Genet. 2000 Fall;97(3):189-94.

377

Seltzer GB, Schupf N, Wu HS. A prospective study of menopause in women with Down’s syndrome. J Intellect Disabil Res. 2001 Feb;45(Pt 1):1-7.

378

Cosgrave MP, Tyrrell J, McCarron M, Gill M, Lawlor BA. Age at onset of dementia and age of menopause in women with Down’s syndrome. J Intellect Disabil Res. 1999 Dec;43 ( Pt 6):461-5.

580

Coppus AM, Evenhuis HM, Verberne GJ, Visser FE, Eikelenboom P, van Gool WA, Janssens AC, van Duijn CM. Early age at menopause is associated with increased risk of dementia and mortality in women with Down syndrome. J Alzheimers Dis. 2010;19(2):545-50.