“ CHANGING CARE WITH CHANGING BODIES AND CHANGING NEEDS ! - A health awareness module for women Dr.Maninder Ahuja Geriatric Gynaecology Committee of FOGSI Chairperson public Awareness committee IMS Dr.Maninder Ahuja Geriatric Gynaecology Committee of FOGSI Chairperson public Awareness committee IMS 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah

“The woman is an axle around whom not only the family or society but the whole universe revolves”. Her health is of utmost importance in all stages of her life….. more so in menopause “The woman is an axle around whom not only the family or society but the whole universe revolves”. Her health is of utmost importance in all stages of her life….. more so in menopause A Woman is the pivot of the Universe! 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah

“Fit at 40” “ Independent at 80” “Strong at 60” We have changed to from 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 3

Our Aim offer a better quality of Life Prevent disabilities Functional independence Prevent cancers Treat Medical & other menopausal problems offer a better quality of Life Prevent disabilities Functional independence Prevent cancers Treat Medical & other menopausal problems 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 4

Why is Menopause so significant ? Because the no. of years lived after menopause is increasing The life span of a woman has increased from 23 years in the Roman era to 65 years in India and 80 years in developed countries 1/3rd of a woman’s life is spent after Menopause. The life span of a woman has increased from 23 years in the Roman era to 65 years in India and 80 years in developed countries 1/3rd of a woman’s life is spent after Menopause. Year Age (Year) Source: US Dept of Health and Human Services; 1999;47(28). 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 5

Comparison of post menopausal women worldwide over the years Source : World Bank Report 1990By 2030 Worldwide population 470 million1.2 billion Developed countries 40%24% Developing countries 60%76% 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 6

Menopause defined There should be absence of menses for 12 months Average age years Can be surgically induced Premature menopause before 40 years of age There should be absence of menses for 12 months Average age years Can be surgically induced Premature menopause before 40 years of age 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 7

Menopause – its implications Ovaries do not produce eggs! Estrogen levels fall No periods No pregnancy 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 8

There are always two sides of a coin 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 9

Women’s perception of menopause Varies from person to person Positive Relief from monthly period No contraception required No pregnancy worries No pregnancy worries Advantages of senior citizen in society Advantages of senior citizen in society Positive Relief from monthly period No contraception required No pregnancy worries No pregnancy worries Advantages of senior citizen in society Advantages of senior citizen in society Negative Fear of old age Isolation and loneliness Disturbance by symptoms of menopause & changing body image Negative Fear of old age Isolation and loneliness Disturbance by symptoms of menopause & changing body image 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 10

Why do we reach menopause? At puberty, the ovaries produce two female hormones, estrogen and progesterone and a male hormone, androgen. Gradually, as a woman approaches her midlife years, the production of these hormones slows down and eventually stops altogether at menopause. Gradually, as a woman approaches her midlife years, the production of these hormones slows down and eventually stops altogether at menopause. Contd.. 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 11

Hormones ESTROGENS PROGESTRONES ANDROGENS 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 12

Role of Estrogen Estrogen is the “female” hormone responsible for the change from girlhood to womanhood Contd.. 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 13

Role of Progesterone Progesterone is the hormone which helps to support a pregnancy if it occurs Contd..Contd.. 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 14

Role of Androgens Androgen is the hormone responsible for the growth of axillary and pubic hair, mood and desire for sex Contd.. 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 15

The female hormone -estrogen It helps To maintain the body shape of a woman To regulate monthly periods To keep the tissues of skin, blood vessels & reproductive tract healthy To regulate mood and behavior patterns To promote sex drive To keep cholesterol levels lower To preserve bones It helps To maintain the body shape of a woman To regulate monthly periods To keep the tissues of skin, blood vessels & reproductive tract healthy To regulate mood and behavior patterns To promote sex drive To keep cholesterol levels lower To preserve bones 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 16

Menopause comes in phases! Premenopause-regular cycles, fertility maintained Peri menopause-irregular cycles, may have symptoms fertility suboptimal Peri menopause-irregular cycles, may have symptoms fertility suboptimal MenopauseNo periods for 12 months, may have Menopause – No periods for 12 months, may have symptoms – no fertility MenopauseNo periods for 12 months, may have Menopause – No periods for 12 months, may have symptoms – no fertility 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah

Initially 7 symptoms were associated with menopause 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 18

But now this mid life crisis has about 35 symptoms! VASOMOTOR SYMPTOMS Hot flushes Mood changes Depression Sleep disturbances Fatigue VASOMOTOR SYMPTOMS Hot flushes Mood changes Depression Sleep disturbances Fatigue Contd.. 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 19

Symptoms contd.. UROGENITAL SYMPTOMS Dryness of vagina Dysuria Urinary Leak Urinary Frequency Sexuality problems UROGENITAL SYMPTOMS Dryness of vagina Dysuria Urinary Leak Urinary Frequency Sexuality problems Contd.. 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 20

MUSCULOSKELETAL Sarcopenia / weakness of muscles Joint aches and pains Osteoarthritis Osteoporosis MUSCULOSKELETAL Sarcopenia / weakness of muscles Joint aches and pains Osteoarthritis Osteoporosis Contd.. Symptoms contd.. 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 21

Menstrual irregularities Unintended pregnancy Palpitation Muscle and joint pain Low backache Dryness of skin Hair loss, nail problems Eye problems Gum and teeth problems Menstrual irregularities Unintended pregnancy Palpitation Muscle and joint pain Low backache Dryness of skin Hair loss, nail problems Eye problems Gum and teeth problems Symptoms contd.. 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 22

Long term problems Forgetfulness,Alzheimer’s OsteoporosisHeart disease OTHERS Arthritis Diabetes Hypertension Problems of Hearing, vision Contd.. 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 23

Long term problems METABOLIC Increased risk of CHD Hypertension More chances of diabetes Alzheimer / loss of memory METABOLIC Increased risk of CHD Hypertension More chances of diabetes Alzheimer / loss of memory 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 24

 These cancers are not because of menopause but are there in this age group  Cancer cervix  Cancer breast  Cancer ovaries  Cancer endometrium 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 25

Some Myths and Facts Myth - Menopause is natural with no clinical consequences Myth - Menopause is natural with no clinical consequences Fact – It does have clinical consequences Contd.. 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 26

Some myths and facts Myth - No treatment is necessary Fact - Treatment is necessary for a better quality of life Contd.. 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 27

Some myths and facts Myth - Menopausal women should not be offered HRT Fact - HRT is definitely recommended as an option for symptomatic menopausal women Contd.. 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 28

Some myths and facts Myth – Menopause has no effect on mental health Fact - Menopause and low estrogen levels are associated with depression 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 29

What are hot flushes? Feeling of “heat” in the face & upper body followed by cold sweats Can occur any time in the day or night Can occur any time in the day or night Can disturb sleep Can disturb sleep Can cause feeling of fatigue Can cause feeling of fatigue Can be accompanied by irritability, mood swings, depression Can be accompanied by irritability, mood swings, depression Feeling of “heat” in the face & upper body followed by cold sweats Can occur any time in the day or night Can occur any time in the day or night Can disturb sleep Can disturb sleep Can cause feeling of fatigue Can cause feeling of fatigue Can be accompanied by irritability, mood swings, depression Can be accompanied by irritability, mood swings, depression 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 30

What can be done? Wear loose clothes preferably inlayers Cool down the body temperature with moist wipes Cool down the body temperature with moist wipes Try to relax Try to relax Yoga Yoga Meditation Meditation Wear loose clothes preferably inlayers Cool down the body temperature with moist wipes Cool down the body temperature with moist wipes Try to relax Try to relax Yoga Yoga Meditation Meditation 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 31

Other methods to prevent hot flushes The following are suggested to reduce an attack Avoid spicy food Avoid coffee, tea, alcohol Eat lentils, Soya products, Wear loose cotton clothes Avoid hot water bath just before sleeping Alternative medicines like isoflavones Medical treatment options like Hormone therapy The following are suggested to reduce an attack Avoid spicy food Avoid coffee, tea, alcohol Eat lentils, Soya products, Wear loose cotton clothes Avoid hot water bath just before sleeping Alternative medicines like isoflavones Medical treatment options like Hormone therapy 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 32

Vaginal symptoms Vaginal dryness Itching Itching Irritation Irritation Pain on urination Pain on urination Discomfort associated with sexual activity Discomfort associated with sexual activity Bleeding during intercourse Bleeding during intercourse Vaginal dryness Itching Itching Irritation Irritation Pain on urination Pain on urination Discomfort associated with sexual activity Discomfort associated with sexual activity Bleeding during intercourse Bleeding during intercourse 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 33

Menopausal changes in the vagina Thinning of liningThinning of lining Loss of foldsLoss of folds Less erectile tissueLess erectile tissue Less lubrication, so drynessLess lubrication, so dryness Less acidic, so more chances of infectionLess acidic, so more chances of infection 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 34

Urinary problems in menopause Leak of urine on coughing, sneezing, bending - stress urinary incontinence – a social problem Unable to hold urine – urge incontinence Frequency in urination Retention with overflow Leak of urine on coughing, sneezing, bending - stress urinary incontinence – a social problem Unable to hold urine – urge incontinence Frequency in urination Retention with overflow 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 35

Management of urogenital symptoms Water based lubricants/no baby creams or hand lotions Local estrogen preparations For urinary symptoms, bladder diary Urine examination Tests for incontinence Kegels exercises Surgery Bladder training Water based lubricants/no baby creams or hand lotions Local estrogen preparations For urinary symptoms, bladder diary Urine examination Tests for incontinence Kegels exercises Surgery Bladder training 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 36

7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 37 Minimally-invasive and simple surgical option to treat incontinence Completed in 30 minutes can be done under local anesthesia Patient returns home the same day Minimal post-op pain 96% success rate –85 % patients completely cured –11% patients experience significant improvement Minimally-invasive and simple surgical option to treat incontinence Completed in 30 minutes can be done under local anesthesia Patient returns home the same day Minimal post-op pain 96% success rate –85 % patients completely cured –11% patients experience significant improvement

Reduced sexual desire DYSPAREUNIADYSPAREUNIA Reduction of orgasmic capacity Reduce sexual satisfaction Negatively influencing sexual motivation Decline in libido Decrease frequency less lubrication 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 38

Management Lubricating jellies Estrogen Vaginal cream Estrogen Vaginal cream Mood elevators Mood elevators Hormone replacement therapy Hormone replacement therapy 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 39

Remaining in Part 2 7/2/2015 Dr.Maninder Ahuja,dr.Duru shah 40