Menopause

Presented by :- Bhagwat kaur

M.sc. sem 2nd
Menstruation – The beginning
● Menstruation (also known as a period, among other colloquial
terms) is the regular discharge of blood and mucosal tissue from
the inner lining of the uterus through the vagina.
● The menstrual cycle is characterized by the rise and fall of
hormones. Menstruation is triggered by falling progesterone levels
and is a sign that pregnancy has not occurred.
Menstruation – The beginning
● The first period, a point in time known as menarche, usually begins between the
ages of 12 and 15.
● Menstruation starting as young as 8 years would still be considered normal.
● The typical length of time between the first day of one period and the first day
of the next is 21 to 45 days in young women.
● In adults, the range is between 21 and 31 days with the average being 28 days.
● Bleeding usually lasts around 2 to 7 days.
● Menstruation, and with it the possibility of pregnancy, ceases after menopause,
which usually occurs between 45 and 55 years of age.[4]
Menopause
● Menopause is derived from Greek word :
Mens ......... Monthly
Pausis ....... Cessation

● Menopause is a part of a women’s natural ageing process when her ovaries

produce lower level of the estrogen & progesterone and when she is no longer
able to become pregnant.
● Menopause is the physiologic cessation of menses associated with declining
ovarian function.
● It is usually considered complete after 1 year of amenorrhea (absence of
menstruation)
Definition
Menopause is the permanent cessation of menstruation at the end of
reproductive life due to loss of ovarian follicular activity.
● Natural menopause is secondary amenorrhea for more than 6
months (12 months) in a woman aged 45 years or over without
any pathological cause.
● Average age of menopause = 51 years.
● Menopause before the age of 40 years is called premature
ovarian failure (POF)mm
Phases of menopause
➤ It has 4 phases :-
Premenopause
• Pre-menopause is broadly defined as the entire
woman’s life before menopause. During this
phase, a woman will have regular periods, can
bear children and the sex hormones like estrogen
and progesterone retain a steady balance
 Perimenopause
•Perimenopause is the period of time leading up to the ‘menopause’.
Medically,the menopause actually refers to the point in time when haven’t had
a period for 12 months but the term is used much more widely to describe the
process of transition in women when they change from being able to
reproduce to not being able to – this is when the ovaries stop producing eggs
and stop making estrogen.

The perimenopause is the whole duration of time from when first start having
menopausal symptoms and– for most women – periods start to change, right
up to the ‘menopause’ point in time. It might just be months but for most
women, perimenopause lasts for many years.
 Symptoms of Perimenopause
• Period changes – this is often the first sign might experience a
change in flow(periods may be heavier or lighter) and periods can
become closer together or more irregular, before stopping
completely.

• Hot flushes – this is the most common symptom of all,

affecting three out of four women. Hot flushes can come on
suddenly at any time of day, spreading throughout face, chest
and body.
 Symptoms of Perimenopause
Night sweats - many women find they wake up drenched in sweat and have to
change their pyjamas or bed clothes. This can also be a disruptive symptom for
partners too.
Mood changes – mood changes can be very disruptive to work and home life.
Mood changes more common if have had premenstrual syndrome or postnatal
depression in the past.
Hair and skin changes – lower levels of estrogen can affect collagen
production, resulting in skin changes, including fine lines, dryness, itching and
tingling. Fluctuating and falling levels of hormones can make hair thinner and less
glossy, and increased facial hair growth.
 Symptoms of Perimenopause
Vaginal and urinary symptoms – low estrogen can cause the tissues
around the vagina to become thinner, dry, itchy and inflamed – known as
vaginal atrophy.Vagina also expands less easily which can make using
tampons, sexual intercourse and having smear tests more uncomfortable.
Low estrogen also thins the lining of the bladder, leading to the urge to
urinate more frequently and desperately at times. Some women also
find they have recurrent urinary tract infections.
Menopausal

It is the end of menstruation age of menopause

ranges between 45-55 years Menopause refers to
a specific period, and that is the last period. Once a
woman has gone through a period of 12
consecutive months without experiencing a
menstrual cycle is called Menopause. The ovaries
stop releasing eggs.
 Diagnosis of menopause
1. AGE:- around 50 years is average (range=45-55 yrs.)

2. Genetically predetermined

3. Thinner women have early menopause

4. Cigarette smoking & severe malnutrition will leads to early

menopause

5. Amenorrhea 12 months

6. Menopausal symptoms
Clinical diagnosis for confirmation

Following stoppage of menstruation (Amenorrhea)

for 12 consecutive months without any pathology.
• As such, a woman is declared to have attained
menopause only retrospectively.
Causes of menopause

When ovaries are totally depleted of eggs and no

amount of stimulation from the regulating hormones
can force them to work.
Other causes
Premature ovarian failure (POF)
Surgeries that removes both ovaries and uterus.
Some types of chemotherapy.
Stress
• Usual onset: 49 and 52 years of age.
Physiological changes in
menopause
 changes in general apperance

◆SKIN:
✔Looses its elasticity due to loss of elastin and collagen from the skin.
Become thin and fine
◆ Weight:
✔Increases due to irregular food habits due to mood swings.
◆ Hair:
✔Dry, coarse and hair loss due to decrease level of estrogen .
◆ Fat:
✔Increase deposition of fat around the hips, waist & buttocks.
◆ Voice:
✔Become deeper due to thickening of vocal cords
 Changes due to metabolism of body
◆ Cholesterol levels:
✔Increases in the blood. This leads to gradual rise in the risk of
heart disease & stroke after menopause.

◆ Calcium levels:
✔Calcium loss from the bone is increased in 15 years after
onset of menopause resulting in loss of bone density.

✔Bone loss-3-5%/yr. Due to low level of estrogen.

✔Calcium moves out of bones, leave them weak & liable to

fracture at the smallest stress (osteoporosis).
 Changes due to metabolism of body

◆ Digestive stress:
✔More activity of entire digestive system is diminished
✔Intestines tends to be sluggish leads to constipation.

◆ Urinary system:

✔Due to low level of estrogen; tissue lining the urethra & bladder become drier,
thinner & less elastic and causes increase frequency of passing urine as well as
increase tendency to develop UTI.
Changes in genital organs
◆Uterus:

✔Atrophy of muscles

✔Small & fibrotic uterus

◆ Cervix:

✔Smaller appear to flush with vagina

✔In older women it become impossible to differentiate with vagina

✔The vaginal & cervical discharge decreases in amount & later disappears
completely.
Changes in genital organs
◆ Ovaries:
✔smaller & shriveled

✔Increase amount of androgen secretion leads to secretion of androstenedione

and testosterone.

✔Which leads to facial hair growth and change in voice

✔In obese women, there is more fat in the body which leads to more secretion
of androgen & are more prone to endometrial hyperplasia and endometrial
carcinoma.
Psychological changes in menopause
Are mainly manifested by:

✔Frequent headache
✔Irritability, mood disturbance, aggressiveness, tension
✔Fatigue, memory loss & problem with concentration
✔Depression, anxiety & instable mood
✔Sleepiness, insomnia, phobias, tearfulness ad low self-
esteem.
✔All are occur due to changes in hormonal levels.

Diminished change in interest due to;

✔Emotional upset
✔Secondary to dyspareunia
✔Dry vagina
Management
Non hormonal treatment
Life style modification
Nutritious diet
Supplementary calcium
Exercise
Vitamin D
Cessation of smoking and alcohol
Hormone Replacement Therapy
NON-HORMONAL TREATEMENT

◆ There are variety of menopausal treatments both

natural and medical that can alleviate the symptoms of
menopause:
◆ Dressing in light layers can alleviate hot flashes and
night sweats; avoiding caffeine, alcohol and spicy foods
can also minimize these symptoms.
◆ Menopause and weight gain tend to go together due to
life style changes than to the hormonal changes. Reducing
dietary fat intake and regular exercise help to combat
weight gain during menopause.
 ◆ Menopause can lead to osteoporosis
Calcium ,magnesium and vitamin D can help restore bone
density, which naturally deteriorates after age 30 due to
reduced estrogen level.

◆ Menopause decreases vaginal elasticity, leading to

vaginal dryness. Vitamin E can help as kegal exercises to
restore elasticity. Using water based lubricants during sexual
intercourse also minimizes discomfort related to vaginal
dryness.
 Hormone replacement therapy
Hormone Replacement Therapy (HRT) is indicated in
menopausal women to overcome the short-term and
long-term consequences of estrogen deficiency.

■ HRT can be administered orally (in pill form), vaginally

(as a cream), or transdermally (in patch form) because it
replaces female hormones produced by the ovaries.

■ Hormone replacement therapy minimize menopause

symptoms. It can be used before, during and after
menopause.
Post menopausal

• This phase is the time after which women has

experienced 12 consecutive months of amenorrhea
without period.
• Women in postmenopause are at increased risk for
osteoporosis and heart disease.
• In this stage for the rest of a women’s life hormone
levels will remain low and women no longer have a
monthly period. She can’t get pregnant because your
ovaries have stopped releasing eggs.
Symptoms of Postmenopausal

• Vaginal dryness :- vaginal lining is lubricated

with fluid that helps keep it thick and elastic.
Vaginal dryness happens when the tissues in your
vagina are dry, thin and not well-moisturized.
• The hormone estrogen helps keep vaginal lining
moisturized and healthy. Low levels of estrogen
cause your vaginal walls to become thin and dry.
Symptoms of postmenopause

Urinary incontinence :- Urinary incontinence is a

loss of bladder control that’s commonly seen in older
adults and women who have given birth or gone through
menopause.
Depression :- estrogen hormone flutuation can lead to
depression
 Risk of postmenopause
Postmenopause increased risk of several conditions :-
Cardiovascular diseases :-
Estrogen helps protect against cardiovascular diseases like heart attack, heart
disease and stroke. It is also common for people in postmenopause to become
more sedentary, which contributes to high cholesterol and high blood pressure.
These factors combined can increase a woman’s risk for cardiovascular diseases
after menopause.

Osteoporosis :-
People lose bone more rapidly after menopause due to decreased levels of
estrogen. You may lose up to 25% of your bone density after menopause
(approximately 1% to 2% per year). When too much bone is lost, it increases your
risk of developing osteoporosis and bone fractures. The bones of the hip, wrist, and
spine are most commonly affected.