• Brief illustrate of terms related to menopause.
• Menopause: age, pathophysiology, hormone
level, anatomical changes, menopausal
symptoms and treatment.
• Postmenopausal bleeding: etiology, clinical
features, diagnosis and investigations.
• Wadha is 54 years old saudi from oneiza is house wife
and mother of 2 sons and 8 daughters.
• Chief complain: vaginal bleeding, abdominal pain and
• History of presenting illness: slight vaginal bleeding since
1 day, lower sudden moderate progressive abdominal
pain not radiated since 1 day the diarrhea frequency is
more than 10 time not associated with blood or mucus
• Past history:
medical: arthritis and right hand swelling.
surgical: cessarian section and hysterectomy since months
due to 2 kg fibroid uterus.
• Family history: no
• Social history: healthy house wife and her husband is
• Review of systems:
GI: slight neasea, no fever, lower abdominal
pain diarrhea.no weight loss and no vomit.
menstrual history: menache 13
menopause: no just after hysterectomy.
cycle length and frequency:28/6
postmenopausl bleeding: slight vaginal bleeding.
• Discharge: yellowish slight not iching and no resh since 2
• Abdominal pain:
bowel problems here diahrea is due to
Obstetric history: 2 sons and 8 daughters got normal vaginal
delivery except last one got cessarian section.
GE: HR is 80. coulour, respiration is 18 term: 37.
BP is 70/139. no alarm signs such
abdominal examination especially palpation
will reveal if there is a tumor.
Gynae examination: speculum and bimanual
• Evaluation: DD:
vulva: vulvitis, benign and malignant lesions and
vaginal tumor: benign or malignant or foreign body.
• Plan: investigations and diagnostic techniques.
laparscopy if ultrasound pick a pelvic tumor.
Important terms related to menopause
• Perimenopause: is period of 3-4 years before
menopause and followed by a year of amenorrhea.
• Menopause: timed of cessation of ovarian function
resulting in permenant amenorrhea. It take 12
months to confirm that it is menopause.
• Late menopause: menstruation continues beyond
52 year sometimes it is normal due to healthy
habits, and due to developed ovarian cancer or
• Postmenopausal bleeding: normaly after 1 year of
amenorhea vaginal bleeding is occuring.
• Occuring between 45-50 years average is 47
• It is difficult to see women after age of 50
menstruate well this delayed menopause
could be due to good nutrition.
• Menopausal age differences is not related to
menarche race, socioeconomic status, number
of pregnancies and lactation or usage of oral
contraceptives. ( who agree?)
• Ovarian activity decline, initially ovulation fails so, no
corpus luteum and no progesterone secreted in ovary.
So, the premenopausal cycles are often anovulatory
• later, grafian follicle fails to develop estrogenic activity
reduction and endometrial atrophy leads to
• Homones levels:
50% reduction in estrogenic production.
66% reduction in estrogen at menopause.
E2, oestrone, FSH, androgens, testesterone, LH and
Risk factors for menopause related diseases
Chemotherapy especially alkalytic agents.
Smoking, caffeine and alcohol.
Family history of menopausal diseases.
Drugs such GnRH, heparin, corticosteiroids, and
clomphene(anti-estrogen)when given over prolonged
period( anti estrgenic) can lead to estrogenic
• Atrophy and regression of genital organs.
• Menopausal symptoms: sudden
cessation, gradual decrease of menses until to
stop and gradual of length of cycle.
• 60 to 70% without symptoms.
• Hot flushes: waves of vasodilation affect face
and neck last for 2-5 minutes each followed by
• Irritability an lack of concentration.
• Libido changes.
• Dysuria without infection.
arthritis, osteoporosis, cardiovascular, stroke, s
kin changes, prolapse of genital tract.
HRT which protect against
symptoms, stroke, alzheimer disease and colonic
• Normally 1 year of amenorrhea then vaginal
bleeding occuring after 6 months of amenorrhea.
vulva: trauma, vulvitis, benign and malignant
erosion, cervicitis, polyp, decubitus, ulcer in
prolapse and malignancy.
Uterus: senile endometriosis, tubercular