1. MENOPAUSE  A natural, normal physiological change.  Permanent cessation of menstruation.  Not a disease or a medical problem.  From reproductive life to non-reproductive life.  Complex mix of areas: physical physical social social psychological psychological cultural cultural spiritual spiritual

2. MENOPAUSE  Long transition period leading to menopause: climacteric, a.k.a. perimenopause climacteric, a.k.a. perimenopause  Age: 35-60 35-60  Climacteric: ovaries less and less responsive to FSH ovaries less and less responsive to FSH decline of estrogen and progesterone production decline of estrogen and progesterone production

3. MENOPAUSE  Climacteric (Cont’d): ovulation skips: anovulatory cycles ovulation skips: anovulatory cycles periods less blood, shorter, skips, irregular periods less blood, shorter, skips, irregular less testosterone less testosterone  Still capable of reproduction  Menopause: 12 continuous months without a period 12 continuous months without a period

4. MENOPAUSE  Some estrogen and progesterone produced by: adrenal glands adrenal glands skin skin muscle muscle brain brain pineal gland pineal gland hair follicles hair follicles  These hormones stored in fatty tissue

5. MENOPAUSE  Universal signs of menopause: cessation of menses cessation of menses cessation of ovulation cessation of ovulation decreased hormonal output decreased hormonal output vaginal dryness vaginal dryness skin changes skin changes

6. MENOPAUSE  Non-universal changes hot flashes hot flashes tachycardia tachycardia headaches headaches memory lapses memory lapses fatigue fatigue irritability irritability depression depression  Cultural differences

7. MENOPAUSE  “Associated” medical conditions: Osteoporosis (brittle bones) Osteoporosis (brittle bones) Heart Disease Heart Disease  Osteoporosis: Bones lack calcium, become weak, easily broken. North American diet relatively high in calcium. No correlation between amount of Ca++ in diet and incidence of osteoporosis (Asia). Bones lack calcium, become weak, easily broken. North American diet relatively high in calcium. No correlation between amount of Ca++ in diet and incidence of osteoporosis (Asia).

8. MENOPAUSE  Osteoporosis (Cont’d): But – excess of protein in the diet results in Ca++ loss during metabolism. But – excess of protein in the diet results in Ca++ loss during metabolism. Prevention: Prevention: exercise (aerobic and weights)exercise (aerobic and weights) good diet, phytoestrogensgood diet, phytoestrogens no smokingno smoking

9. MENOPAUSE  Osteoporosis (Cont’d):  Men also get osteoporosis after about age 50 yet they do not suffer “estrogen deprivation”. Women 1 in 4, men 1 in 8 Women 1 in 4, men 1 in 8  Muscle mass helps to prevent osteoporosis. Men usually have more muscle due to testosterone.  Baseline bone density test, repeat 5 years

10. MENOPAUSE  Heart Disease: Uncommon until 20 th century Uncommon until 20 th century Longevity: Longevity: women’s life expectancy from 48 to 84.women’s life expectancy from 48 to 84. Genetics and Lifestyle Genetics and Lifestyle

11. MENOPAUSE  Heart Disease (Cont’d)  Factors that increase incidence: excess weightexcess weight consumption of ‘bad’ fatsconsumption of ‘bad’ fats sedentary lifesedentary life smoking (first and second hand)smoking (first and second hand) contraceptive pillcontraceptive pill These are cumulative: greater effects with increased age. These are cumulative: greater effects with increased age. Same preventative measures as for osteoporosis. Baseline for blood pressure and stress test. Same preventative measures as for osteoporosis. Baseline for blood pressure and stress test.

12. MENOPAUSE  Hormone Replacement Therapy (HRT): Completely discredited today. HRT can cause: Completely discredited today. HRT can cause: reproductive cancersreproductive cancers heart diseaseheart disease dementiasdementias asthmaasthma hearing losshearing loss memory lossmemory loss and other health problems and other health problems

13. MENOPAUSE  Exercise: as essential as breathing and eating as essential as breathing and eating Benefits: Benefits: healthy weighthealthy weight energyenergy mental acuitymental acuity antidepressantantidepressant strengthens immune system, lower incidence of all morbiditystrengthens immune system, lower incidence of all morbidity stress busterstress buster

14. MENOPAUSE  Exercise (Cont’d): Benefits: Benefits: improves sex lifeimproves sex life sweating important for cleaning toxins, skinsweating important for cleaning toxins, skin cardiovascular health: lower incidence of heart attacks and strokescardiovascular health: lower incidence of heart attacks and strokes lower incidence of osteoporosislower incidence of osteoporosis low incidence of menopausal symptomslow incidence of menopausal symptoms helps with balance in old agehelps with balance in old age

15. MENOPAUSE  Exercise (Cont’d): Should be a life-long habit. Lifestyle coadjuvants: Should be a life-long habit. Lifestyle coadjuvants: no smokingno smoking balanced dietbalanced diet good sleep habitsgood sleep habits

16. MENOPAUSE  Exercise (Cont’d): Barriers: Barriers: urbanizationurbanization TVTV computerscomputers desk jobsdesk jobs multiple demands on women, double shiftmultiple demands on women, double shift affluence, mechanization (cars, shopping, etc.)affluence, mechanization (cars, shopping, etc.) pharmaceutical culturepharmaceutical culture no tangible cultural rewardsno tangible cultural rewards not a serious part of school curriculumnot a serious part of school curriculum not part of traditional female rolenot part of traditional female role

17. MENOPAUSE  Psycho-Socio-Cultural Aspects of Menopause: In Western cultures menopause is associated with decline and with loss of status for women. In Western cultures menopause is associated with decline and with loss of status for women. Aging seen as loss of value. Aging seen as loss of value.

19. MENOPAUSE  Fear of Aging Associated With Menopause Causes: negative expectations negative expectations negative thoughts and emotions negative thoughts and emotions defeatist behaviours defeatist behaviours So menopausal symptoms are magnified.So menopausal symptoms are magnified.

20. MENOPAUSE  Cultural Influences: “Sex for procreation only” “Sex for procreation only” “Sex is for the young” “Sex is for the young” “Old people who have sex are dirty and disgusting” “Old people who have sex are dirty and disgusting”

21. MENOPAUSE  Culture and Menopause: Androcentric Image of Women: Androcentric Image of Women: sexysexy youngyoung fertilefertile Post-Menopausal women: Post-Menopausal women: drydry witheredwithered unattractiveunattractive  Advertising  Medicine

22. MENOPAUSE  Importance of youth reinforced by: cosmetic industry cosmetic industry fashion industry fashion industry cosmetic surgery fad cosmetic surgery fad medical-pharmaceutical industry medical-pharmaceutical industry Western illness model is very profitable.Western illness model is very profitable.

23. MENOPAUSE  Some Cultures Associate Menopause with: power power wisdom wisdom high social status high social status leadership roles leadership roles respect respect  In these cultures women have few complaints about menopause

24. MENOPAUSE  Menopause and Sex: 50% report more enjoyment: 50% report more enjoyment: no fear of pregnancyno fear of pregnancy partners slowerpartners slower more self-assuredmore self-assured Use of artificial lubricants Use of artificial lubricants Vagina: Vagina: use it or lose it (atrophy)use it or lose it (atrophy)

25. ANDROPAUSE  Male Climacteric (Male Menopause or Andropause) 40-55 40-55  Some real physical changes – less obvious than women  Confounded with normal aging changes: less energy less energy slower RT (reaction time) slower RT (reaction time) less vigorous responses less vigorous responses

26. ANDROPAUSE  And With Disease effects: diabetes diabetes circulatory circulatory depression depression surgery surgery medications medications hypercholesterolemia hypercholesterolemia kidney problems kidney problems prostate problems prostate problems

27. ANDROPAUSE  Testosterone Drops: testosterone maintains muscle, stimulates bone health, so less testosterone leads to reduced muscle mass and weaker bones. testosterone maintains muscle, stimulates bone health, so less testosterone leads to reduced muscle mass and weaker bones.  Sperm Count: also affected (drops) due to testosterone drop. also affected (drops) due to testosterone drop.

28. ANDROPAUSE  Sexual Performance Declines: increased episodes of impotence increased episodes of impotence genitals shrink, prostate enlarges genitals shrink, prostate enlarges more time to reach arousal more time to reach arousal erections less hard erections less hard ejaculations less forceful, less quantity ejaculations less forceful, less quantity increased refractory period increased refractory period

30. ANDROPAUSE  Estrogen Drops: estrogen helps cardiac health, prevents atherosclerosis, counteracts LDL cholesterol, so less estrogen increases probability of atherosclerosis (arterial plaque) and of “bad” cholesterol. estrogen helps cardiac health, prevents atherosclerosis, counteracts LDL cholesterol, so less estrogen increases probability of atherosclerosis (arterial plaque) and of “bad” cholesterol.  More and more men on HRT. Sildenafil (Viagra) Sildenafil (Viagra) Cialis Cialis Levitra Levitra

31. ANDROPAUSE  HRT for Men: Testosterone Testosterone Can causeCan cause prostate cancer prostate cancer prostate enlargement prostate enlargement blood clots blood clots lower HDL (the ‘good’ cholesterol) lower HDL (the ‘good’ cholesterol) heart disease heart disease Same prevention: Same prevention: lifestylelifestyle