2. The terms climacteric and menopause are often used interchangeably actually they have different meanings. The climacteric is the period of waning ovarian function which signal the end of the reproductive life span. Menopause is the stoppage of menses. Menopause is a normal stage of life experienced by women all over the world. It occurs typically between the ages of 40 and 65 years womens when the ovaries stop producing the hormones estrogen and progesterone, which are responsible for the monthly menstrual cycles. When the ovaries stop making these hormones, the menstrual cycles stop as well.

3. The climacteric The climacteric is characterized by endocrinal, somatic and transitory psychological changes. The climacteric may be classified into three phases: Pr-menopausal phase: The period of beginning physiological failure of ovarian function and it lasts for a period ranging from two to six years. Menopausal phase. Post menopausal phase: The remainder of life after menopause. The age of menopauses ranges from 40 to 50 years

4. Types of menopause Physiological menopause. Pathological menopause. Premature menopause. Artificial menopause Delayed menopause

5. Physiological menopause: It is spontaneous progressive decline of ovarian function that starts at the age of 40 to 50 years. Pathological menopause Premature menopause: It is premature ovarian failure before age of 40.years and affect 1% of all women under the age of 40. Artificial menopause: It is permanent cessation of ovarian function caused by surgical removal of the ovaries or by irradiation using either intra uterine radium or deep x-ray with about 600 rads. Delayed menopause: It is a cessation of menstruation above the age of 50.

6.  ↓in circulating estrogen and progesrton, ↑ production of gonadotrophin. (changes differ from woman to another) 1)Breast changes: ↑ subcutaneous fat, but later due to ↓in circulating estrogen, subcutaneous fat resorbed, atrophy of the gland tissue, the breast flattened and pendulous. 2) Female genital organs:  Ovaries: ↓ size, non functional and unable to respond to circulating gonadotrophins.  Uterus and tubes: Become progressively atrophic.  Vagina and vulva: Thinning of the mucosa, easily irritated ↓vaginal secretion (↓ acidity), pathogenic organisms can be developed, atrophy of the vaginal epithelium may cause dyspereunia.  Urethra: Atrophy of mucosa and development of urethritis.  Pelvic floor muscles : loss of their tones, loss of elasticity of connective tissue, development of prolapse and stress incontinence

7. 3. Cardiovascular system: Vasomotor disturbance, Hot flushes with feeling of heat centered on the face which spreads to the neck and chest and may become generalized. Each hot flush lasts between 1.5 and 3 minutes, associated with peripheral vasodilatation and increase of heart rate. Symptoms of hot flashes may include some or all of the following: A feeling of extreme warmth Sweating that is sudden and may be drenching Fatigue Irritability Headaches Joint pain Interruptions in sleep or night sweats Hot flashes may be followed by a feeling of extreme cold and shivering. Vaginal dryness, which may lead to pain during intercourse, is another symptom of menopause that some women experience.

8. 4. Psychological changes: irritation, depression and insomnia. 5. Obesity due to:  ↑appetite and alteration of carbohydrate metabolism as a result of hyper function of anterior lobe of pituitary gland. 6. Osteoporosis affects more the vertebrae with one or more of the following:  Bone pain: back pain (most common) due to declines of vertebral mineral content.  Fractures: Thoracic, spinal wedge, lumber, hip and colles fractures of the wrist.  Loss of height: compression fractures of vertebrae, kyphosis.  Deformities: e.g. thoracic kyphosis in two forms, Round kyphosis: when several vertebrae are affected (smooth thoracic curveture) Angular kyphosis; when only one or few vertebrae are affected (Dowager hump)

9. General treatment Hormonal treatment Medical treatment Preventive treatment

10. General treatment: oReassurance (through proper explanation about this changes. oImprove general health. oDiet control (avoid obesity) Hormonal treatment: oAdministration of estrogen, estrogen with progestrogens hormones. Medical treatment: sedative drugs and calcium intake. Preventive treatment: oA program of regular aerobic and resistance exercises and training to prevent or minimize many problems such as cardiovascular diseases, obesity, depression and osteoporosis.

11. Cardiovascular diseases increase in women after menopause, regular aerobic exercises to improve cardiovascular endurance and reduce the risk of cardiovascular diseases The recommended exercises should be 30 minutes at a time, three times / week at 60% of maximum oxygen consumption (VO2max)

12. Obesity is a risk factor for cardiovascular diseases and diabetes. Aerobic exercises will lead to decrease of abdominal fat due to several mechanisms including, ↑energy expenditure, ↑metabolic rate and altered body composition. The recommended exercises should be 60 minutes / day, three times / week at 50 of maximum oxygen consumption (VO2max)

13. Regular exercises weight bearing exercises e.g. (walking, jogging and climbing stairs) and non weight bearing exercises e.g. (bicycle, swimming and spine exercises are most conservative and least costly measures to provide protection against bone loss The recommended exercises should be 30 minutes / day, three times / week at 60 of maximum oxygen consumption (VO2max)

14. Exercises raises brain nor-epinephrine concentrations and prevents depression, Aerobic exercises (walking or jogging) leads to high concentration of nor-epinephrine and serotonin.

15. The possible mechanism of exercises for keeping the skeletal integrity are: 1)Change blood biochemical structure:  skeletal remolding is modulated by calcium, phosphours, and calcitrophic hormones availability during and after exercises increase bone mineral density.  Intense interval exercise at 60% (VO2max) will cause ↑ the plasma concentration of sex hormone estrogen. 2) Mechanical load of exercises: will cause ↑bone mass  Muscle contraction and gravity create piezo electric forces which affect bone remolding, compression of bone causes negative potential at the compressed site and positive potential else where, causing osteoblatic activity at the negative end of the current flow, causing increased deposition of calcium at the compression site.

16. Methods used for prevention of osteoporosis 1.Electromagnetic fields (EMFs) Pulsating electromagnetic field (PEMFs) with 10 micro volt/cm and frequency between 50-150 Hz one hour/day are able to slow down the loss of bone mass. Mechanism of action: Piezo electric potentials in loaded bone affect skeletal mass. It causes a maximum potential gradient which able of increasing net calcium flux in human osteoblast like cells. It maintain a constant high osteogenetic activity and osteogenesis and reduce the resorption on the bone surface. 2. Pulsed ultrasonic: With frequency of 1.5 MHz and intensity from o.5 to 2 W/cm for 10 minutes/day had effect on the rate of bone regeneration. Mechanism of action: By electromechanical kinetic effect on the cell membrane interfaces of the bone. 3. Electrical stimulation: Can be used to stimulate bone regeneration.