2. MENOPAUSE AND THE CLIMACTERIUM in a nutshell Prof Greta Dreyer

3. Definitions Climacterium – The time around the menopause when ovarian function decreases Menopause – Last menstruation – Diagnosed in retrospect after 6 months amenorrhoea

4. The effects of decreasing sex steroids ESTROGEN Genital organsDecreased menses Thinning Dryness Atrophy

5. The effects of decreasing sex steroids ESTROGEN NON genital organsBone deminerization Collagen decrease Increase in LDL Brain contains ER…

6. The effects of decreasing sex steroids PROGESTERONE Genital organsIncreases ER sensitivity Decreased cycle control Breast atrophy NON genital organsAdds to bone deminerization Largely unknown Adds to collagen decrease

7. Symptoms of the climacterium and early menopause Vasomotor instability(flushing, sweating) Psychological change(sleep, well-being, memory loss) Urogenital atrophy(vaginitis, dryness, bladder) Other(libido, skin, hair, etc)

8. Complications of the menopause BONE LOSS Osteoporosis with loss of height, kiphosis, pain, fractures CARDIOVASCULAR DISEASE Coronary heart disease Cerebral vascular incidents (due to atherosclerosis)

9. AIMS OF MANAGEMENT OF CLIMACTERIUM AND MENOPAUSE Manage Symptoms Safely Prevent Later Complications Determine individual risk profile Consider timing of interventions “Holistic”

10. MANAGEMENT OF CLIMACTERIUM AND MENOPAUSE Determine necessity and duration and route and timing and type of HT Evaluate complication risks of HT Evaluate necessity of alternative interventionslifestyle medication

11. Determine individual risk profile Family history Medical history MEDICAL EXAMINATION BP BMI weight distribution Gynaecological examination SPECIAL TESTS BMD Lipid profile, CRP Mammogram

12. Non HT treatment of symptoms Vasomotor instabilityGeneral measures Antidepressants Psychological changeGeneral measures Antidepressants Urogenital atrophySexual activity lubricants

13. NON HT prevention of complications of the menopause BONE LOSS Calcium, exercise, prevention of fractures CARDIOVASCULAR DISEASE Lipid lowering with diet and statins Exercise, treatment of other risk factors, weight control, HT, smoking, DM

14. THE END