Peri menopausal period syndromePresentation Transcript
Peri-menopausal Period Syndrome (Climacteric Syndrome) www.freelivedoctor.com
the cessation of menses for a year or more.
It is caused by ovarian failure.
It marks the end of a women’s reproductive life
It occurs normally between the ages of 45– 55
years and at a mean age of 51 years.
It is a physiological process
Peri-menopause is a period immediately before and after the menopause. www.freelivedoctor.com
Premature ovarian failure ----- the cessation of menses before the age of 40 years. Artificial menopause ------ the cessation of menses is secondary to some causes, such as oophorectomy, radiation therapy. www.freelivedoctor.com
Peri-menopausal Period Syndrome
peri-menopause accompanied by the symptoms of climacteric, including hot flashes, excessive perspiration, night sweets, depression, agitation, vaginal dryness, insomnia
The basic causes of the climacteric syndrome are a progressive decline in ovarian production on estrogens and other sex hormones
Negative Feedback Secretion of estrogens decreased (ovary) ↓ FSH increased (40-45 years old) ↓ FSH,LH increased(45-50 years old) ↓ FSH increased 14 times LH increased 3 times(menopause) ↓ FSH, LH gradually decline (3 years after menopause) www.freelivedoctor.com
Symptoms and signs 1. Early Symptoms and signs
1) menstraution disorder
Oligomenorrhea--- intervals greater than 35 days.
Polymenorrhea---- intervals less than 21 days
2) vasomotor symptoms( hot flashes, sweats)
oestrogen depletion result in instability in the vessels of the skin.
The hot flashes begins on the chest and spreads quickly over the neck, face and upper limbs which lasts only seconds but may recur many times one day. Sweat often follows hot flashes.
3) mood changes and sleep disturbances
insomnia, headache, backache, depression, hate,
having difficulty falling asleep and waking up soon after going to sleep
4)urinary tract problem
atrophic change in the urethrovesical epithelium
decreased elastic tone of the uterine and urethrovesical supporting structures
5)vaginal dryness and genital tract atrophy atropic vaginitis, dyspareunia
the vaginal skin become thin and loses its rugose appearance
small red spots appear on the vagina
2. Late symptoms and problems 6)osteoporosis
Accelerated bone loss in women is clearly related to the loss of ovarian function.
Studies show that a rapid decrease in bone mass occures within 2 months of ovariotomy
After natural cessation of ovarian function, bone loss 3% yearly for the first 6 years
By age 65, half of women have bone density decreased by 2 standard deviations below the perimenopausal mean.
Beyond age 45, the incidence of wrist fractures is 12 times higher in women than in men of same age
There is now general agreement that postmenopausal osteoporosis is related to estrogen deficiency
Estrogen reduce bone resorption more than they reduce bone formation
lack of exercise Malabsorption of calcium www.freelivedoctor.com
7) cardiovascular lipid changes
HDL,LDL, total cholesterol ,
perimenopaual women have a lower incidence of coronary heart disease than men of same age.
This observation led to the supposition that estrogen might be a key factor.
But recent data suggest that Estrogen has no such protection against heart disease
Diagnosis 1)History menstrual abnormality 2)Symptoms: vasomotor symptoms, vaginal dryness, urinary frequency, insomnia, irritability, anxiety, skin change, breast changes, urinary tract problem, pelvic floor change( cystocele. Rectocele. Prolapse), skeletal change(backache, ) and so on. www.freelivedoctor.com
3)Physical examination: The clinical findings vary greatly depending on the time elapsed since menopause and the severity of the estrogen deficiency
Skin: thin ,dry
Breast loss turgor
The labia are small
The uterus becomes much smaller
The muscles of the pelvic floor are looser in tone and are thin