1. Menopause
Reproductive health

2. Definition of Menopause
WHO defined natural menopause (the permanent cessation of menstruation resulting from loss of ovarian follicular activity which occurred after 12 consecutive months of amenorrhea).
Climacteric is defined as (the phase in the aging women which marks the transition from reproductive state to non reproductive state).

3. Definitions Related to Menopause
Perimenopause :(1-2 year immediately before menopause or it is the whole reproductive period prior menopause ,it is characterized by menstrual irregularities )
Post menopause :(dating from the menstrual period regardless of wither the menopause was induced or spontaneous)

4. Importance of Topic
Menopausal women at more risk to develop cardiovascular diseases and osteoporosis on the long term effect, which affect the quality of life.
Menopausal women complaining from morbidity including urinary incontinence , urinary tract infections , reproductive infections and genital prolap.

5. Importance of Topic
little attention is provided to the menopausal women ,here in Jordan there isn’t available services to the menopausal women, because most of the health care focuses on the pregnant women during childbearing years, as the essential role of the woman is childbearing(Mahadeen, et al., 2008).

6. Age of Menopause
Worldwide the average age of menopause is 50yeras with a range of 45-55yeras.
The median age of menopause in Jordan is 50-51years, Jordanian women are living longer than their male counterparts with a life expectancy of 71 years (Jordan Department of Statistics 2005).
Menopause is affected by the woman's health , weight ,nutrition, life style ,culture and genetic factors.

7. Factors Affecting Menopause
Self concept
Physical health
Marital stability
Relationship with others
Cultural values
Education

8. Research finding Among Jordanian Women
In a qualitative research done by(Mahadeen, et al., 2008) of 25 peri menopausal Jordanian women to study their perception of menopausal transition , they found that Jordanian women considered menopause as a life transition with no reproduction leading to a stage of freedom, relief and rest, Jordanian women valued the menopausal stage and consider it as a stage of wisdom ,so their perception was positive(Mahadeen, et al., 2008).
Becoming menopausal decreased women worries about pregnancy and gave them time to pray regularly and fast all the month of Ramadan without any interruption, therefore Jordanian women tended to have positive attitude toward menopause (Gharaibeh, et al., 2010).

9. Menopausal Symptoms
Vasomotor symptoms
Vaginal symptoms
Urinary symptoms
Physical symptoms
Psychological symptoms

10. Remember
Menopause is highly individualized and each women dealing with it in different way, although the biological changes are same , the symptoms vary in intensity ,frequency and severity from one women to another. There is short term symptoms and long term symptoms.

11. Vasomotor Symptoms Hot flashes Night sweats Sweating Palpitations
Insomnia,
sleeping disturbances
Shivering
Increased pulse
Feeling faint and nausea

12. Vaginal and Urinary Symptoms
Vaginal infection
Post_ coital bleeding
Painful sex
Itching or irritation
Decreased libido
Decrease lubrication
Urinary frequency /urgency
Stress and urge incontinence

13. Physical Symptoms Decreased fitness and flexibility
Changes in distribution of body fat
Changes in sleep patterns

14. Psychological Symptoms
Nervousness
Anxiety
Moody changes
Irritability, confusion
Depression
Forget fullness
Poor self esteem
Deterioration in memory
Psychosexual dysfunction

15. Long Term Symptoms
Cardiovascular symptoms which is considered as the leading cause of death in women and its incidence increased after menopause, increased risk for coronary heart diseases(CHD) hypertension and strokes.

16. Risk Factors for CHD Family history of heart diseases Advancing age
Overweight and obesity
Cigarette smoking
Hypertension
Diabetes
Elevated cholesterol

17. Osteoporosis One in three of all women develops Osteoporosis
The incidence increases
in post menopause
due to the reduction
in estrogen levels

18. Risk Factors for Osteoporosis
Personal history of fracture
Current low bone mass
Advanced age
Family history of osteoporosis
Low intake of calcium
Vitamin D deficiency
Cigarette smoking
Inactive life style

19. Remember
Negative attitudes toward menopause affect the severity of menopausal symptoms, therefore nurses need to reassure the women about normalcy of menopause to make coping and adaptation.

20. Management of Menopause
life style changes
Complementary treatment
Hormonal Replacement Therapy (HRT)

21. life Style Changes
Regular exercises to prevent coronary heart diseases
lowering weight to increase bone density
Avoidance of stress and stressful situation
Decrease in caffeine and alcohol intake
Smoking cessation
Proper nutrition
Being in the sun light
taking vitamins and calcium

22. life Style Changes To use appropriate moisture
to manage any vaginal dryness
Keep cool patches and sprays under pillows at night to help manage hot flushes and night sweats

23. Complementary Therapy
Acupuncture
Homeopathy
Aromatherapy
Massage
Use of herbs
Cognitive behavior therapy
Group therapy

24. Hormonal Replacement Therapy (HRT)
It is effective to relieve vasomotor
urogenital and psychological
symptoms .
It is available in many forms and
a variety of routes , including oral
transdermal and intrauterine.

25. Remember Estrogen alone is given to women who
undergone hysterectomy , it increased the
risk of endometrial cancer.
Progesterone and estrogen given to
women with intact uterus.

26. Hormonal Replacement Therapy (HRT)
The current advice is to use the lowest dose for the shortest possible time ,many women who stop HRT find that symptoms return again.

27. Before Starting HRT
Pap smear
Measurement of cholesterol, lipids ,liver enzymes
Base line mammogram
Endometrial biopsy

28. Hormonal Replacement Therapy (HRT)
HRT is contraindicated in women with recent thromoemboilitic disease or sever liver disease, in special forms and in certain circumstances , it will increase the risk of breast cancer in women aged above 50 years , and also older patients who are taking certain types of HRT may also be at increased risk of ischemic stroke.

29. References
Agnew, Y. (2010). Dealing with menopause -- Go with the flow. Sister Namibia, 22(2),
Brockie, J. (2008). Physiology and effects of the menopause. Nurse Prescribing, 6(5),
Gharaibeh, M., Al-Obeisat, S., & Hattab, J. (2010). Severity of menopausal symptoms of Jordanian women. [Article]. Climacteric, 13(4), doi: /
Holloway, D. (2011). An overview of the menopause: assessment and management. Nursing Standard, 25(30),
Mahadeen, A. I., Halabi, J. O., & Callister, L. C. (2008). Menopause: a qualitative study of Jordanian women's perceptions. [Article]. International Nursing Review, 55(4), doi: /j x
Pitkin, J. (2010). Cultural issues and the menopause. Menopause International, 16(4), doi: /mi
Senba, N., & Matsuo, H. (2010). Effect of a health education program on climacteric women. Climacteric: The Journal Of The International Menopause Society, 13(6),
Strauss, J. R. (2011). Contextual Influences on Women's Health Concerns and Attitudes toward Menopause. Health & Social Work, 36(2),
Yangin, H. B., Kukulu, K., & Sozer, G. A. (2010). The Perception of Menopause Among Turkish Women. [Article]. Journal of Women & Aging, 22(4), doi: /

30. Any Questions ?
Thank you