1. Peri-menopausal Period Syndrome (Climacteric Syndrome) www.freelivedoctor.com

3. It is caused by ovarian failure.

4. It marks the end of a women’s reproductive life

5. It occurs normally between the ages of 45– 55

6. years and at a mean age of 51 years.

7. It is a physiological processPeri-menopause is a period immediately before and after the menopause. www.freelivedoctor.com

8. 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

10. The basic causes of the climacteric syndrome are a progressive decline in ovarian production on estrogens and other sex hormoneswww.freelivedoctor.com

11. 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

13. Polymenorrhea---- intervals less than 21 days

14. hypermenorrhea

15. amenorrhea

16. menopausewww.freelivedoctor.com

18. 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.www.freelivedoctor.com

21. decreased elastic tone of the uterine and urethrovesical supporting structureswww.freelivedoctor.com

23. small red spots appear on the vagina www.freelivedoctor.com

25. Studies show that a rapid decrease in bone mass occures within 2 months of ovariotomywww.freelivedoctor.com

27. By age 65, half of women have bone density decreased by 2 standard deviations below the perimenopausal mean.

28. Beyond age 45, the incidence of wrist fractures is 12 times higher in women than in men of same agewww.freelivedoctor.com

30. Estrogen reduce bone resorption more than they reduce bone formation

31. Other factorslack of exercise Malabsorption of calcium www.freelivedoctor.com

33. HDL,LDL, total cholesterol ,

34. perimenopaual women have a lower incidence of coronary heart disease than men of same age.

35. This observation led to the supposition that estrogen might be a key factor.

36. But recent data suggest that Estrogen has no such protection against heart disease www.freelivedoctor.com

37. 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

39. Breast loss turgor

40. The labia are small

41. The uterus becomes much smaller

42. The muscles of the pelvic floor are looser in tone and are thin

43. Prolapse may be presentwww.freelivedoctor.com

45. E2, FSH, LH determination

46. Radiography, X-ray densitometrywww.freelivedoctor.com

48. The use of estrogens can relieve the menopausal symptoms.

49. The hot flashes , sweats and other complaints disappear or improve within a few days of starting estrogens therapy.www.freelivedoctor.com

51. So, correct cyclical therapy, with 10 days progestogen per month , can reduces the incidence of cancer.www.freelivedoctor.com

53. hypertension

54. diabetes

55. chronic liver disease

56. myomo, endometriosis,

57. breast disease

58. gallbladder diseasewww.freelivedoctor.com