MENOPAUSE

INTRODUCTION:

 Menopause is the end of menstruation.

 The word menopause came from the Greek
word 'meno' meaning ‘monthly’ and ‘pausis’
meaning ‘cessation’.
 Menopause is a part of a women’s natural
ageing process when her ovaries produce lower
level of the estrogen and progesterone.
DEFINITIONS:

 Menopause means permanent cessation of

menstruation at the end of reproductive life due
to loss of ovarian follicular activity. It is the point
of time when last and final menstruation occurs.
 Menopause is the permanent cessation of
menstruation at the end of reproductive life due
to loss of ovarian follicular activity.
AGE OF MENOPAUSE:

 Age is genetically predetermined. The age of

menopause is not related to age of menarche
or age at last pregnancy.
 Cigarette smoking and severe malnutrition
may cause early menopause. Early

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 menopause is seen in cases following
chemotherapy, ovarian resection.
 The age of menopause 45-55 years
 Average 50 years.
PHASES OF MENOPAUSE:

 Pre-menopause
 Peri-menopause
 Menopausal phase
 Post menopause
PREMENOPAUSE is defined as no symptoms of
menopause or perimenopause. Pre menopause
lasts an average of 30 to 35 years.
Some of the most common symptoms are:
 Irritability
 Anxiety
 Headaches
 Abdominal cramps
 Breast tenderness
PERIMENOPAUSE is the time starting few years
before continuing after the period of onset of
menopause.
The most characteristic symptoms are:
 Irregular periods

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  Mood swings
 Hot flashes
 Night sweats
 Vaginal dryness
 Loss of libido
MENOPAUSE means Once a woman has gone 12
consecutive months without a period, she has
officially entered menopause.
POSTMENOPAUSE is the last phase of
menopause, that comes after the menopause.
The common symptoms are:
• Osteoporosis
• Incontinence
• Urinary tract infections
• Heart disease
• Dyspareunia

CAUSES OF MENOPAUSE:
• Surgical removal of the ovaries
• Chemotherapy and radiation therapy
OTHER SYMPTOMS:
1)MENSTRUAL CHANGES:
• Short cycles
• Irregular bleeding
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2)VASOMOTOR SYMPTOMS:
• Hot flashes
• Night sweats
• Anxiety, lack of sleep
3)PSYCHOLOGICAL SYMPTOMS:
• Irritability
• Mood swings
• Poor memory
• Depression
4)SEXUAL DYSFUNCTION:
• Vaginal dryness
• Loss of libido
5)URINARY:
• Incontinence
• Urgency
• Dysuria
6)OTHER SYMPTOMS:
• Back aches
• Joint aches
• Weight gain

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TESTS:
HISTORY COLLECTION:
• Menopause is usually considered
complete after 1 year of amenorrhea.
• Tests typically aren’t needed to diagnose
menopause:
• But under certain circumstances, doctor
may recommend blood tests to check your
level of FSH and estradiol and Thyroid
Stimulating Hormone(TSH).
DIAGNOSIS:
• Average age of menopause 50 years
• Appearance of menopausal symptoms
• Vaginal cytology.
MANAGEMENT:
1)TREATMENT
• A) Non-harmonal treatment
• B) Harmone therapy
2)PREVENTION
3)COUNSELLING

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1)TREATMENT:
A) NON-HORMONAL TREATMENT:
• 1)Life style modification
• 2)nutritious diet
• 3)supplementary calcium and vitamin D
• 4)exercise
• 5)vitamin E
1. Lifestyle modification: this includes
physical activity (weight-bearing),
reducing high coffee intake, smoking
and excessive alcohol.
2. Nutritious diet: balanced with calcium
and protein is helpful.
3. Supplementary calcium: daily intake of
1-1.5g can reduce osteoporosis and
fracture.
4. Vitamin-D: supplementation of vitamin
D3(1500-2000IU/day) along with
calcium and can reduce osteoporosis
and fractures. Exposure to sunlight
enhances synthesis of cholecalciferol
(vit.D3) in the skin.
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 5. Exercise: weight bearing exercises,
walking and jogging.
6. Vitamin E: vitamin E reduces hot
flashes (25%).
B) HORMONE THERAPY:
• The Hormone Therapy (HT) is indicated in
menopausal women to overcome the
short-term and long-term consequences of
estrogen deficiency.
INDICATIONS OF HORMONE THERAPY:
• Relief of menopausal symptoms
• Relief of vasomotor symptoms
• Prevention of osteoporosis
SPECIAL GROUP OF WOMEN TO WHOM
HT SHOULD BE PRESCRIBED:
• Premature ovarian failure
• Surgical or radiation menopause
BENEFITS OF HORMONE THERAPY:
• Improvement of vasomotor symptoms (70-
80%)
• Increase in Bone mineral density (2-5%)
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 • Decreased risk in hip fractures (25-50%)
• Reduction in colorectal cancer (20%)
CONTRAINDICATIONS OF HORMONE
THERAPY
• History of breast cancer
• Undiagnosed genital tract bleeding
• History of Deep Vein Thrombosis (DVT)
• Active liver disease
• Prior Endometriosis
RISKS OF HORMONE THERAPY:
• Endometrial cancer
• Breast cancer
• Venous thromboembolic (VTE) disease
• Coronary heart disease (CHD)
• Dementia, Alzheimer
AVAILABLE PREPARATION FOR
HORMONE THERAPY:
• ORAL ESTROGEN REGIME
• ESTROGEN AND CYCLIC PROGESTIN
• TRANSDERMAL ADMINISTRATIONS
• SUBDERMAL IMPLANTS
• PERCUTANEOUS ESTROGEN GEL
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 • TRANSDERMAL PATCH
• VAGINAL CREAM
• PROGESTINS
• LEVONORGESTREL INTRAUTERINE
SYSTEM (LNG-IUS)
• TESTOSTERONE
• PARATHYROID HORMONE
DURATION OF HT USE:
• Most women are able to stop taking HRT
after their menopausal symptoms finish,
which is usually two to five years after
they start (but in some cases this can be
longer).
• Gradually decreasing your HRT dose is
usually recommended, rather than
stopping suddenly.
2) PREVENTION:
• Spontaneous menopause is unavoidable.
• However artificial menopause induced by
surgery, radiation or chemotherapy during
reproductive period can to some to extent
be prevented or delayed.

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3) COUNSELING:
• It is important to understand the
individual’s need and priorities when
providing counselling.
 KEY POINTS:
• The decision-making process
• Problem reported by women.

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