1. MENOPAUSE Definition:
Menopause is physiological cessation of menstruation due to exhaustion of primordial follicles in the ovary climatric  initiate period of weaning ovarian function.
[The ovary age between [45-55] average 50]

2. MENOPAUSE Hormonal changes after menopause:
Pituitary Gn mainly FSH  to loss of –ve feed back mechanism with estrogel.
Later on the FSH
Estrogen . The main source of estrogen is:
Supra renal gland
Good amount of circulating conversion of androstendion into estrone in the adopise tissues
Androgen  slightly
Thyroid gland  slight hypothyroidism
Progesterone  absent

3. Menopausal symptoms: 1. Vasomoter  hot flushes and sweating ( FSN)
2. Psychological 
irritability
Depression
Headache
insommia
3. Rheumatic pain 
Due to osteoporosis ( estrogen)
osteothritis

4. Menopausal symptoms: 4. Gastro interstinal erect  5. Obesity 
dyspesia
Constipation
5. Obesity 
Increase appetite
Due to alteration in CHO metabolism
6. Sexual 
Lipido
dyspareunia

5. General changes after menopause Breast 
Shrivelled
Flat
Bone  as a result of increase estrogen
Osteoporosis  backpain
Spinal compression 5 times 2.5. height
Celles fracture 10;  mobility
Hand 0.3/1000 ; 20/100; % die  and fracture of vertebral body, humerous, upper femme distal forearm and ribs.
Atherosclerosis
Hypertension
Coronary heart diseases

6. Uterus  small and lined with basal layer of endometirum only.
Vulva 
loss of fat from labia
Narrow entroitsus
Vagina 
the epithelium is thin and atrophic
Loss of vaginal rugae
Glycogen deposition
Alkaline PH  senile vaginitis
Uterus  small and lined with basal layer of endometirum only.
Ovaries  ovaries shrunken and atrophic
Pelvic cellular tissue and ligament – lax
Menstruation  may stop suddenly or gradual in amount or in pregnancy

7. Emotional changes after menopause;
Some women may develop – depression
Anxiety
Nervousness
Depresssion.

8. Management of the climatric – menopausal symptoms
1. General treatment:
Reassurance
Avoid obesity
Improve the general condition
2. Medical treatment:
Sedative may be indicated
3. Hormonal treatment
Estrogen – control hot flushes by inhibiting FSH
Estrogen and progesterones – progesterone used to prevent of endometrial hyperplasia  so that result from estrogen alone.
Androgen – may be use to FSH But they have androvirilising effect

9. 4. Other consideration
Women receiving Ga & phosporous should have blood test for Ca & phosporous yearly for the first 2 years.
Clomidine  to reduce hot flushes but it is less effective.

10. Menopausal symptoms: Gastro interstinal erect  Obesity  Sexual 
dyspesia
Constipation
Obesity 
Increase appetite
Due to alteration in CHO metabolism
Sexual 
Lipido
dyspareunia