Menopause

MENOPAUSE

Definition

          Menopause is defined as the permanent physiological cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity.

          It’s the point of time when the last and final menstruation occurs.

Climacteric

          Climacteric is the phase of aging process during which a woman passes from the reproductive to the nonreproductive stage.

          This phase covers 5-10 years on either side of menopause.

Premenopausal

          It’s the part of the climacteric before menopause. When the menstrual cycle is liked to be irregular.

          Postmenopause is the phase that comes after the menopause.

Age of menopause

 

Ø  Age of menopause is genetically predetermined.

Ø The age of menopause ranges between 45 to 55 years average being 50 years.

Ø Cigar ate smoking and severe malnutrition may cause early menopause.

Endocrinology of climacteric and menopause

1.     Depletion of the ovarian follicle in the prior stage of menopause.

·        Resulting in increasing FSH level.

·        The serum level of estradiol from 50-300pg/ml before menopause to 10 to 20pg/ml after menopause.

2.     The diminished folliculogenesis result in anovulation olio goes ovulation and corpus luteum insufficiency.

3.     Shorting of the follicular phase leads shorter menstrual cycle.

4.     There is a fall in the level of prolactin and inhibition.

Organ changes

                 

Organ changes

                                          I.            Genitourinary system

a)     Ovaries – shrink in size.

b)    Wrinkled and white.

1.     Fallopian tube

a)     Atrophy

b)    Muscle coal become thinner. become less prominent.

c)     Plicate become less prominent.

2.     Uterus

a)     Smaller

b)    Endometrium become thin and atrophic

c)     Cervical secretion becomes scandy.

3.     The vagina

a)     Atrophy

b)    Labia become flattened

c)     Pubic hair become scantier resulting in a narrow introit.

4.     Breast

a)     Gland become atrophy

b)    Nipple decrease in size

                   The breast becomes flat and pendulous.

               II.            Skeletal system

Loss of bone mass by about 3% - 5% per year due to deficiency of estrogen leading to osteoporosis.

           III.            Cardiovascular system

Deficiency of estrogen increases the risk of cardiovascular disease of its function of decreasing high-density lipoprotein cholesterol and antioxidant property.

v  Menstruation pattern prior to menstruation

Ø Abrupt cessation of menstruation.

Ø Gradual decrease in both amount and duration.

Ø Irregular with or without excessive bleeding.

v Symptoms of menopause

A.   Menstrual changes

Ø Shorter cycle

Ø Irregular bleeding

B.   Vasomotor symptoms

Ø Hot flashes

Ø Night sweat

Ø Sleep disturbances

C.   Psychological changes

Ø Irritability

Ø Mood swings

Ø Poor memory

Ø Depression

D.   Sexual dysfunction

Ø Vaginal dryness

Ø Dyspareunia

E.   Urinary changes

Ø Incontinence

Ø Urgency

Ø Dysuria

F.    Others

Ø Backaches

Ø Joint aches

Diagnosis of menopause

Ø Cessation of menstruation for consecutive 12 months during climacteric.

Ø Average age of menopause 50 years.

Ø Appearance of menopausal symptoms, hot flashes and night sweat.

Ø Vaginal cytology – low estrogen.

Ø Serum estradiol - < 20 pg/ml.

Ø Serum FSH and LH - > 40 mool/ml

v Management

1.     Prevention

Ø Spontaneous menopause is unavoidable.

Ø Artificial menopause induced by surgery ( bilateral oophorectomy ) or radiation or chemotherapy during the reproductive period can to some extent be prevented or delayed.

2.     Counseling

Ø Every woman with postmenopausal symptoms should be adequately explained about the physiological events.

v Treatment 

1.     Non-hormonal therapy

2.     Hormonal therapy

1. Non-hormonal therapy

A.   Lifestyle modification

Ø Increase physical activity

Ø Reducing high coffee intake

Ø Stop smoking alcohol

B.   Nutrition diet

Ø Balanced with calcium and protein.

C.   Supplementary calcium

Ø Daily intake of 1 – 1.5 q can reduce.

v Hormonal therapy

Ø Replacement of estrogen and progesterone are prescribed for women with premature ovarian failure.

v Benefits of hormonal therapy

Ø Improvement of vasomotor symptoms.

Ø Improvement of urogenital atrophy.

Ø Decreased risk of vertebral and hip fracture.

Ø Reduction in colorectal cancer.

Ø Possibility cardioprotection.

v Contraindication hormonal therapy

Ø History of breast cancer.

Ø Liver disease.

Ø Jaundice

Ø Gall bladder disease.

Ø Endometritis.

v Abnormal menopause

Ø Premature menopause – below age 40 years.

Ø Delayed menopause – above 55 years.

Ø Artificial menopause – surgical removal ovary.

Ø Surgical menopause – bilateral oophorectomy.

Ø Radiation menopause – gamma radiation leads to menopause below          40 years.