MENOPAUSE

DEFENITION Menopause means permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity

CLIMACTERIC Is the period of time during which a woman passes from the reproductive to non reproductive stage 5-10 years on either side of menopause PERIMENOPAUSE Part of the climacteric when the menstrual cycle likely to be irregular POSTMENOPAUSE Phase of the life that comes after menstruation

AGE OF MENOPAUSE Genetically predetermined Ranges between 45-55 years Average 50 years

PHYSIOLOGICAL CHANGES REPRODUCTIVE CYCLE Ovary responds to Gonadotropins A follicle matures The ovary secretes estrogen Ovulation occurs Corpus luteum produces progesterone

PHYSIOLOGICAL CHANGES ESTROGEN LEVEL DECLINE (Responsible for secondary sex characteristics) Organs of reproduction undergo regression Labia becomes thin and pale Vaginal mucosa atrophies Vaginal mucosa loses its lubrication Dyspareunia

Frequent vaginal infection Contd…. Frequent vaginal infection Atrophies of the bladder and urethra(loss of urethral tone and atrophic cystitis) Uterine myoma and endometriosis lesion also atrophy(Advantage) Increased LDL Decreased HDL Hot flashes Fatigue

PSYCHOLOGICAL RESPONSES Menopause called as a change of life Depression Mood swing Irritability Agitation Nervousness Muscle pain Hot flushes at night

MENOPAUSAL SYMPTOMS VASOMOTOR SYMPTOMS- Hot flush(low estrogen level) UROGENITAL ATROPHY (low estrogen level) VAGINAL CHANGES SEXUAL DYSFUNCTION (low estrogen level) SKIN AND HAIR PSYCHOLOGICAL CHANGES DEMENTIA OSTEOPOROSIS AND FRACTURE(due reduction in collagenous bone matrix)

TREATMENT COUNSELLING HORMONE REPLACEMENT THERAPY NUTRITIOUS DIET CALCIUM SUPPLEMENTS EXCERCISE

HORMONE REPLACEMENT THERAPY ESTROGEN AND PROGESTERONE Usually called HRT For women with a uterus Prevents uterine hyperplasia, a precursor to uterine cancer Progesterone make the endometrium shed each month ESTROGEN Usually called ERT Who had hystrectomy,because uterine hyperplasia is not a risk

Reduses the risk of osteoporosis Improves mood and mental well being BENEFITS OF HRT Reduses the risk of osteoporosis Improves mood and mental well being Decreased tooth loss Lowers the risk of colon cancer

Increased risk of blood clot and stroke CHD RISK OF HRT Endometrial cancer Increased risk of blood clot and stroke CHD Increased incidence of gall bladder disease Dementia Alzheimers

CONTRAINDICATION OF HRT Undiagnosed genital tract bleeding Oestrogen dependent neoplasm in the body History of venous thrombosis Active liver and gall bladder disease

SIDE EFFECTS Monthly bleeding Irregular spotting Breast tenderness Blood clot and stroke Fluid retension Head ache Dizziness Skin discolouration Increased breast density Skin irritation