Menopause is defined as the cessation of ovarian function resulting in 12 months of amenorrhea, marking the end of a woman's reproductive years. It typically occurs between ages 48-52, though can be delayed or premature. Initially ovulation fails, then follicles and estrogen levels decline. This leads to endometrial atrophy and amenorrhea. Hormone levels like estrogen decrease and FSH increases. Anatomically, the ovaries, uterus, vagina, and vulva all shrink and atrophy. These changes can cause symptoms like hot flashes and increase risks for osteoporosis, heart disease, and prolapse.

1. MENOPAUSE

2. MENOPAUSE
 Menopause is a physiological and natural event in the life of a
woman.
 It is defined as the cessation of ovarian function resulting in
amenorrhea.
 It takes 12 months of amenorrhea to confirm that menopause
has set in and therefore it is a retrospective diagnosis.

3. AGE OF MENOPAUSE
Menopause normally occurs between the ages of 48 and 52 years, the
average being 49 years.
 Menopausal age is directly associated with: smoking(induces
premature menopause ) and Genetic disposition.
DELAYED MENOPAUSE
 Absence of menopause by 55 years of age is known as delayed
menopause.
 causes: better nutrition and health
women suffering from fibroids
those at high risk of endometrial cancer
PREMATURE MENOPAUSE
 Menopause setting before the age of 40 years.

4. PATHOPHYSIOLOGY
 Initially ovulation fails
Initially ovulation fails
No corpus luteum forms and no
progesterone is secreted
Therefore premenopausal cycles
are often anovulatory and irregular

5. Later graafian follicle
also fails to develop
Oestrogenic activity
is reduced
Endometrial atrophy
leads to amenorrhea.

6. HORMONE LEVELS
HORMONE LEVEL EFFECT
Oestrogen
E2/E1 RATIO<1
10-20pg/mL Predisposes to
osteoporosis and
ischaemic heart disease
FSH(rebound increase in
level in response to
falling estrogen)
>40 IU/L FSH appears in high
concentration in urine.
testosterone 0.1-0.5 ng/mL Mild hirsutism
Growth hormone
Inhibin B
Anti Mullerian hormone
low Low level of growth
hormone also causes
ovarian failure

7. ANATOMICAL CHANGES
 OVARIES: They shrink and their surface becomes grooved and
furrowed.
 The menopausal ovary measures less than 2xi.5x1 cm in size as seen
on ultrasound
 The plain muscle in the fallopian tube undergoes atrophy, cilia
disappear from the tubal epithelium and the tubal plicae are no
longer prominent.
 UTERUS : It becomes smaller because of atrophy of its muscle so that
connective tissue are more conspicuous.
 The endometrium is represented only by the basal layer with its compact
deeply stained stroma , and a few simple tubular glands. The functional layer
and lymphoid tissue disappears.
 The cervix become smaller and its vaginal portion is represented by a small
prominence at the vaginal vault.

8. VAGINA : The vaginal fornices gradually disappear as the cervix shrinks after
menopause.
 The vagina becomes narrow and its epithelium becomes pale, thin and dry
and gets easily affected causing SENILE VAGINITIS.
 The vulva atrophies and the vaginal orifice narrows and this can cause
DYSPAREUNIA.
 The pelvic cellular tissue becomes lax and the ligaments that support the
uterus and vagina lose their tone and these changes predispose to PROLAPSE
OF GENITAL ORGANS, STRESS INCONTINENCE OF URINE AND FECAL
INCONTINENCE.
OTHER CHANGES: Fat is deposited around the breasts ,hip and abdomen.
 Skin wrinkles and hair growth around the chin and lips.