Difference Between Skeletal Smooth and Cardiac Muscles
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Menopause overview
1. An Overview of
Menopause
Associate Prof Dr Hanifullah Khan
2. objectives
! āÆ to understand this condition &
terminology
! āÆ physiology of menopause
! āÆ problems linked with menopause
! āÆ clinical scenarios
3. what is menopause?
! āÆ A physiological loss of ovarian hormonal activity
! āÆ Closely allied to loss of reproductive potential
! āÆ Permanent cessation of the primary ovarian
functions
5. The Ovaries
! āÆ 2 functions - produce ova &
secrete hormones
! āÆ Start secreting estrogen &
progesterone from puberty to
menopause
! āÆ Most of the beneficial effects
derive from estrogen
6. actions of estrogen
! āÆformation of the 20 sex characteristics
! āÆDevelop ovaries, tubes, uterus & vagina
! āÆHPO axis interaction
! āÆendometrial proliferation
! āÆIncreases fat deposition
! āÆmaintain the skin & vessels
! āÆbone - incrrease formation & reduce
resorption
7. actions of
progesterone
! āÆ its actions are amplified in the presence
of estrogen
! āÆ Interacts with hypothalmus and pituitary
to regulate menstrual cycle
! āÆ converts endometrium to secretory stage
! āÆ makes cervical mucous & vaginal
epithelium impenetable to sperm
! āÆ inhibits lactation during pregnancy
! āÆ makes the uterus less contractile
8. When does
menopause occur?
! āÆ Tends to occur over a period of
years
! āÆ A consequence of biological ageing
! āÆ Genetic & environmental factors
! āÆ Malaysian women - 48 - 52 years*
*Jahanfar SH 2006, Ismael NN
1994
9. Types of
menopause
-āÆPremature Menopause - menopause in a woman aged <40
years
-āÆEarly Menopause - menopause in a woman aged 50 - 59
years
-āÆLate Menopause - menopause in a woman aged >60 years
-āÆSurgical menopause - a result of surgical removal of both
ovaries
-āÆMedical menopause -
-āÆ permanent damage to both ovaries - chemotherapy or
radiotherapy
-āÆ temporary - GnRHa tx in endometriosis
10. Perimenopause
-āÆthe time just before and soon after the
occurence of menopause
-āÆsymptoms of menopause have started
-āÆnot yet certain if menopause is established
yet
11. Diagnosis of
menopause
! āÆ The diagnosis of menopause is mainly clinical
ā¢āÆ a. Clinical Criteria
1.āÆ age around menopause ( around 50 years )
2.āÆ no periods for 12 months
3.āÆ menopausal symptoms
ā¢āÆ ( NB. All 3 clinical criteria need not be present for a diagnosis )
ā¢āÆ Laboratory diagnosis is generally not necessary for the diagnosis of
menopause. However, where in doubt, laboratory testing of FSH may support
the diagnosis, viz
ā¢āÆ b. Laboratory Criterion
ā¢āÆ 1. FSH level > 35miu/ml
19. Symptoms
mimicking disease
! āÆ Abnormal vaginal bleeding
! āÆ Perimenopausal
! āÆ Postmenopausal
! āÆ General pains e.g. Breast
20. Perimenopausal
abnormal bleeding
-āÆAt this age, there are many conditions that peak
-āÆ e.g. Adenomyosis, polyps, ļ¬broids, hormonal
-āÆCancers are always a concern, esp Ca Cx
-āÆInfections are the most common occurrence
-āÆAll these must be ruled out before a diagnosis of
perimenopausal bleeding is made
21. Postmenopausal
bleeding
-āÆConsider it as always abnormal
-āÆAlways think of cancer
-āÆUsually due to atrophy or infection
22. Cardiovascular
disease
! āÆ CV risk increases as
estrogen levels
decline
! āÆ 1 in 2 women will
die from
cardiovascular
disease
! āÆ Estrogen exerts
beneficial effects on
CV system through
! āÆ Direct effect on
the vasculature
! āÆ Indirect effect
of lipid
metabolism
Kramarow E et al. Health and Aging Chartbook. Health, United States, 1999. National
Center for Health Statistics; 1999.
23. Cholesterol
metabolism
! āÆ Only total cholesterol,
low-density lipoprotein
cholesterol, and
apolipoprotein B
demonstrated substantial
increases within the 1-year
interval before and after
the FMP, consistent with
menopause-induced
changes. This pattern was
similar across ethnic
groups.
Matthews K. J Am Coll Cardiol. 2009;54(25):2366-2373
24. Fracture risk
! āÆ decreased
bone density
! āÆ osteoporosis
! āÆ common
fractures
involve hip,
forearm &
spine
29. potential risks &
concerns
-āÆBreast cancer
-āÆCardio vascular disease
-āÆVenous thrombosis
-āÆEndometrial cancer
-āÆCompliance/therapy
-āÆThe Women s health initiative study aimed
to conļ¬rm all these
30. Conclusion
ā¢āÆ Estrogen plus progestin was associated with greater
breast
ā¢āÆ cancer incidence, and the cancers are more commonly
node
ā¢āÆ positive. Breast cancer mortality also appears to be
ā¢āÆ increased with combined use of estrogen plus progestin.
ā¢āÆ Writing Group for the Women s Health Initiative Investigators
JAMA. 2010;304(15):1684-1692
31. Current recommendations
-āÆhormone therapy should be initiated for the
treatment of menopause-related symptoms
-āÆthe lowest dose should be used for the lowest
duration
-āÆ 5 years recommended for estrogen+prog therapy
-āÆhormone therapy risks
-āÆ all forms of tx increse risk of VTE (deep vein thrombosis & pukmonary emboli)
-āÆ increased risk of breast Ca with est+prog combination
Stuenkel CA et al. Menopause. 2012;19(8):846-847
33. The important points
! āÆ menopause is a natural occurence
! āÆ it is associated with long- & short-term
issues
! āÆ some of the menopausal symptoms may
mimic medical disorders
! āÆ postmenopausal conditions such as bleeding
& masses must be seriously looked into
! āÆ hormone therapy should be used but it has its
problems
34. Q. A 40 year old woman presented
with no periods for 1 year. How
would you diagnose menopause?