THE CLIMACTERIC

• The interrelated anatomical and physiological changes that occur as

a woman proceeds from her fertile to infertile years are termed the
climacteric

MENOPAUSE
• The word ‘menopause’ is synonymous with the phrase ‘the change of
life’,
• These changes occur because the ovaries become exhausted of viable
follicles; they shrink and fail to produce oestrogens.
 PHYSICAL SYMPTOMS
• HOT FLUSHES AND NIGHT SWEATS: Flushing and sweating occur,
usually over the upper chest, neck and face.
• Sometimes this is triggered by a stressful situation, a hot drink or hot,
spicy food; often, however, there is little or no apparent reason for
these embarrassing and inconvenient events, which may happen
occasionally or many times a day.

VAGINAL SORENESS –ATROPHIC VAGINITIS

• Vaginal and cervical secretions are decreased and become less acid;
the vaginal lining becomes thin, dry and less elastic.
• As a result, the vagina becomes more prone to infection and
vulnerable to soreness, irritation, burning and discharge.
• In addition there may be narrowing of the introitus and dyspareunia
with consequent marital stress.
 URINARY DISORDERS
• Oestrogen receptors are present in the vagina, urethra, trigone and
the pelvic floor (Hex tall 2000).
• It is widely accepted that urogenital problems are associated with
vaginal delivery (Wilson et al 1996), predisposing a woman to the
development of urinary incontinence (stress and/or urge) or prolapse,
or both.
• Although these disorders may develop at any time, symptoms
commonly present, or are exacerbated, at menopause when
declining ovarian function results in oestrogen depletion.
• Atrophy, inflammation and infection of the vagina may have
secondary effects on the urethra and bladder.
 DRY SKIN
• The majority of age-related changes in the skin are secondary to
chronic ultraviolet radiation exposure (Hawk 1998).
• There is also a reduction in epidermal cell turnover rate (up to 50%
reduction by the age of 70), resulting in decreased ability of the skin
to withstand and repair damage.

PSYCHOLOGICAL AND EMOTIONAL SYMPTOMS

• It is known that cholinergic neurons within the brain contain
oestrogen receptors, and that a declining oestrogen level in
postmenopausal women is likely to contribute to impaired cognitive
performance and increased incidence of dementias (Genazzani et al
1998, Perry 1998).
SEXUALITY IN THE CLIMACTERIC
• The consequences of the hormonal transition of menopause are
declining levels of oestrogen and testosterone, the latter being
associated with decreased sexual desire, sensitivity and response.

POSTMENOPAUSAL PROBLEMS
• There are a number of notable squeal of lowered oestrogen levels,
some of which result in significant morbidity and mortality.
• The most critical known effect of oestrogen depletion is an
acceleration of osteoporosis and subsequent fractures.
• Postmenopausal women are also at Increased risk of cardiovascular
disease (CVD)
CARDIOVASCULAR DISEASE
• Following menopause, the incidence of CVD increases as oestrogen
levels diminish; one in every two women who reaches the age of 50
will eventually die of heart disease or stroke (AHA 1997)

OSTEOPOROSIS
• Osteoporosis is defined as ‘a systemic skeletal disorder characterized
by low bone mass and micro architectural deterioration of bone
tissue, with a consequent increase in bone fragility and susceptibility
to fracture’ (Consensus Development Conference 1993)

Prevention of osteoporosis
• Prevention begins in childhood with the establishment of a healthy
lifestyle, and the most significant aspects of this are diet (particularly
calcium and vitamin D intake) and exercise.
Risk factors for osteoporosis (*indicates high risk)
• White or Asian ethnic group*
• Positive family history*
• Slim build/low BMI*
• Low peak bone mass (at age 30)*
• Early menopause or early oophorectomy*
• Elite athletes/excessive exercise, leading to secondary
amenorrhoea
• Poor diet:
• eating disorders
• body fat composition of less than 17%
• calcium and vitamin D deficiency
• excessive or insufficient animal protein
• high phosphate ingestion
• High caffeine intake
• High alcohol intake
• High intake of carbonated drinks
• Cigarette smoking
• Sedentary lifestyle
• Disorders affecting mineral metabolism
• Cushing’s disease
• Rheumatoid arthritis; ankylosing spondylitis
• Corticosteroid treatment
• Long-term debilitating illness which results in decreased activity
or immobilization
• Very rarely, pregnancy
Treatment
• The aim of treatment of established osteoporosis is to alleviate the
patient’s symptoms and to reduce the risk of further fractures.

Reduction of fracture risk

• Falls are a particular problem in the elderly; with ageing comes
vestibular impairment and loss of the righting reflex, so that the
demands of a changing environment cannot be met – for example, a
slippery or uneven surface (hobeika 1999).

Exercise
• Exercise has a vital role to play in the prevention and the management
of osteoporosis; during recent years, researchers have looked at
different exercise regimens and their effect both on prevention of falls
and on bone mass.