Menopause

Ms Bincy Joshwa
Introduction
Climacteric : refers to the phase of decrease in ovarian
activity that begins 2-3 yrs before menopause and
progresses 2-5 yrs following it
Menopause and climacteric are used interchangeably
Onset of menopause occurs at 45-55 yrs of age
Endocrinal changes
The ovarian follicles reduce in no along with decrease
in estrogen and progesterone levels
The levels of inhibin also fall causing an increase in
FSH levels
FSH causes estrogen stimulation
Due to reduced no of follicles the FSH fails to
stimulate the production of estrogen
This results in failure of endometrial development and
absence of uterine bleeding which is observed as
menopause
Clinical features
Vasomotor symptoms: instability of thermoregulatory center due to
estrogen deficiency
Hot flushes
Night sweats
CNS symptoms: due to reduced serotonin levels
Insomnia
Palpitations
Psychological symptoms
Mood changes
Anxiety
Loss of memory
Loss of concentration
 irritability
Alzheimers disease
Reproductive symptoms
Vaginal dryness
Loss of libido
Dyspareunia
Urinary symptoms
Urgency
Frequency
Dysuria
Chronic consequences
Osteoporosis
Cardiovascular disease and strokes
Diagnosis
History and physical examination
FSH >30 IU/L
Pap smear, lipid profile , blood sugar and bone density
Treatment
Emotional support
Counselling
Lifestyle modification –high fibre diet, low fat, rich in
antioxidants , exercise, smoking cessation and
decreased alcohol intake , relaxation and stress
reduction
Medications
Hormone replacement therapy
Who are symptomatic and high risk of developing
cardiovascular disorders, osteoporosis, Alzheimer’s
disorder or colonic cancer
Treated for 3-6 mnths and symptoms are relieved at the
ned of 6 mnths
Estrogen therapy is advised in lowest possible dose that
relieves vasomotor symptoms , prevents vaginal atrophy,
prevents acceleration of atherosclerosis
 Estrogen -0.625 mg
 Progestins-MDPA 5mg for 2 weeks every mnth
Weight bearing excercises
Adequate ultraviolet exposure
Vitamin D>400 IU/day
Calcium supplemenatation -1000mg/d
Stop smoking and alcohol consumption
Avoid excessive caffeine
Post menopausal bleeding
Uterine bleeding that occurs more than 12 mnths after
the last menstrual period of a menopausal woman