MENOPAUSE

MENOPAUSE
1) INTRODUCTION
Menopause also known as climacteric is the end of menstruation.it is part of a woman
ageing process when ovaries produce lower level of estrogen and progesterone. She is
no longer able become pregnant. The period is associated with some medical issues e.g.
post-menopausal bleeding, cancer, hormonal replacement therapy.
2) DEFINITION
Menopause is the permanent cessation of menstruation and end of reproductive life due
to loss of ovarian follicular activity.
3) ETIEOLOGY
Menopause occurs when ovaries are totally depleted of eggs and no amount of
stimulation from regulating hormones can force them to work.
 Natural decline of reproductive hormones
 Hysterectomy
 Chemotherapy/radiation
 Primary ovarian insufficiency
 Removal of the ovaries surgically
4) PHASES OF MENOPAUSE
 Pre menopause
 Time prior to menopause
 Before occurrence of menopause
 Peri menopause
A period characterized by physiological changes associated with declining
reproduction of estrogen /progesterone and declining reproduction capacity
terminating with complications of menopause
 Menopausal phase
It is the end of menstruation The age range from 45 to 55yrs.average 50yrs
 Post-menopausal phase
It is the tin a woman has experienced 12 consecutive month of amenorrhea
without period.
5) INCIDENCE
 Physiological menopause
Decline in ovaries function due to aging between 45-55 years average 50 leading
to anovulation, decreased menstruation function eventualy cessation
 Pathological menopause
Gradual or abrupt cessation of menstruation before 40 Idiopathic 5%
6) CAUSES OF MAENOPAUSE
 Natural decline of reproductive hormones
 Hysterectomy
 Chemotherapy/radiation therapy
 Primary ovaries inefficiency
 Removal of ovaries
7) PHYSIOLOGICAL CHANGES/SIGNS AND SYMPTOMS
The lack of estrogen and progesterone causes many changes in the woman physiology
that affect their health and well being
 Increased cholesterol in the blood

This is common Leading to gradual rise in the risk of heart diseases and stroke
 Osteoporosis
Calcium loss from the bone is increased. There is loss of bone density. Fractures
are common
 Digestive system
Most activity of the entire digestive tract is diminished .constipation is common
 Urinary system
Tissue lining urethra and bladder become drier, thinner and less elastic. This lead
to increased frequency ,UT1
 Uterus
Uterus becomes small and fibrotic due to muscle atrophy. Cervix becomes
smaller. appear to flash with vagina Vaginal and cervical discharge decreases in
amount and later disappeared completely
 Ovaries
They become smaller shrinkled in appearance. Produces estrogen no more.
 Vagina
Vaginal mucous membrane becomes thin loses its rugosity Decrease
secretion, .dry vagina Painful sexual intercourse
 Vulva/external genitalia
Loss of hair Decrease of pubic hair
 Breast
They may become flat in thin women but shriveled in heavy built women. They
remain flabby and pendulous.
8) CHANGES IN THE GENERAL APPEARANCE

 Skin- loss of elasticity(collagen loss) -thin
 Weight — increase (due to poor diet habits ,mood swings)
 Hair - dry ,thin, coarse - Loss
 Voice - deep due to thickening of vocal cords
9) CHANGES IN THE VASOMOTOR SYSTEM

 Hot flashes — Can occur at any time — Vary in numbers — Associated
with profuse sweating
 Night sweats Associated with hot flashes. Can occur at any time Maybe
severe to wake up the patient-suddenly causing panic attack or
palpitation.
10) PSYCHOLOGICAL CHANGES
 Headache
 Irritability
 Fatigue
 Depression
 Insomnia
HORMONAL REPLACEMENT THERAPY
Indications have already been given
Types of HRT
 Estrogen and progesterone

Commonest type Designed for women who have uterus Stop overgrowth of
uterine linings.
 Estrogen only
Those without uterus. no need for progesterone.
 Progestin only
Not used often. Does not provide excellent relief of hot flashes
Commonly used estrogen are conjugated estrogen 0.6 to 1.25mg/day .Progesterone
used are medroxy progesterone (100-300mWday) Lowest effective dose and for short
duration Low dose of oral conjugated estrogen 0.3mg daily is effective with minimal
side effects Subdenmal implants — subcutaneously over the anterior abdominal wall
with local anesthesia Implant — 25mg, 50mg or 100mg are available. Can be kept for 6
months. Percutaneous estrogen. lgm application of gel of lmg of estrogenol daily is
applied onto the skin over anterior abdominal well or thigh.
 Transderrnal
 Vaginal cream
 Tibolone
Its steroid having each estrogemic ,progesteronic and androgenic properties.it prevents
osteoporosis atrophic changes of vagina and hot flashes It increases libido A dose of
2.5mg per day is given Loss of libido
11) TESTS AND DIAGNOSIS
- history
- FSH extraction
- thyroid function tests
12) TREATMENTS
 Non hormonal
- medical or natural
- light dressing reduce dietary fat intake
- regular exercise - calcium, magnesium and vitamin D for osteoporosis
- vitamin E to restore elasticity
-use water base lubricant during sexual intercourse
 Hormonal replacement Therapy
Is indicated in menopausal women to overcome the short-term consequences of
estrogen deficiency. Can be administered orally, vaginaly (cream) or Trans dermally
(patch form)
 Indications
- Relief of menopausal symptoms
- Prevention of osteoporosis
- Premature ovaries failure
-Gonadal
- Surgical or radiation menopause
Duration of HRT
Generally, should be used for a short period of time 3-5yrs. Reduction of dosage should
be done as soon as possible
Risks of HRT
 Endometrial cancer
 Breast cancer
 Venom thrombosis
 Increase incidence of gall bladder disease
 Dementia ,Alzheimer disease increased

MENOPAUSE

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MENOPAUSE

 Increased cholesterol in the blood

8) CHANGES IN THE GENERAL APPEARANCE

9) CHANGES IN THE VASOMOTOR SYSTEM

 Estrogen and progesterone

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