Which physical findings are characteristic of menopause?

Updated: Jun 06, 2018
  • Author: PonJola Coney, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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On pelvic examination, the effects of gonadal hormone depletion (which may be noted before menopause in some women) are as follows:

  • With loss of estrogen, the vaginal epithelium becomes redder as the epithelial layer thins and the small capillaries below the surface become more visible

  • Later, as the vaginal epithelium further atrophies, the surface becomes pale because of a reduced number of capillaries

  • Rugation diminishes, and the vaginal wall becomes smooth

  • The menopausal ovary diminishes in size and is no longer palpable during gynecologic examination

  • The uterus becomes smaller

  • Fibroids, if present, become less symptomatic, sometimes shrinking to the point where they can no longer be palpated on manual pelvic examination

  • In older women, a general loss of pelvic muscle tone occurs, sometimes manifested as prolapse of reproductive or urinary tract organs

Urogenital effects of diminished hormone levels are as follows:

  • A decrease in urine pH leading to a change in bacterial flora may result in pruritus and a malodorous discharge

  • Vaginal changes often result in insertional dyspareunia

  • Endometriosis and adenomyosis are alleviated

  • Atrophic cystitis, when present, can mimic a urinary tract infection

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