1. MENOPAUSE

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

4. 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

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

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

7. 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

8. 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

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

10. 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)

11. TREATMENT COUNSELLING HORMONE REPLACEMENT THERAPY NUTRITIOUS DIET
CALCIUM SUPPLEMENTS
EXCERCISE

12. 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

13. 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

14. 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

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

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