Menopause is signaled by 12 months since last menstruation. Common symptoms include hot flashes and vaginal dryness. There may also be sleep disturbances. The combination of these symptoms can cause anxiety or depression. Menopause is a natural process with treatments that focus on symptomatic relief. Vaginal dryness is treated with topical lubricants or estrogen. Medications can reduce the severity and frequency of hot flushes. In special circumstances, oral hormone therapy may be used.

2. 
Hot flushes
Night sweats
What is •••?

3. 
Hot flushes and night sweats
Very common
A sensation of heat spreads over your
body, in particular your head, face and
chest and is often accompanied by
flushing and sweating, followed by a
chill

4.  Hot flushes!!
 The hallmark and the most commonly associated
symptom with menopause. This is just one of several
symptoms that may occur letting you know that
menopause is on its way
 Though not welcomed, these symptoms tend to be
experienced by the majority of women and are due to
the declining level of oestrogen in the body which up
until now has maintained the ‘hormonal balance’ all
these years
 The body is now moving into a state of readjustment
and learning to live without oestrogen

5. 
Menopause:
last menstrual period
One complete year without a menstrual
cycle
Perimenopause:
transition into menopause. It can last
for 2 to 8 years prior to menopause and
includes the first year after menopause
Definitions

6. 
There are three stages of menopause
that take place over about a decade
Peri-menopause
Menopause
Post-menopause

7. 
Definition:
In about 2/3 of the women in
perimenopausal period ,there appear
a series of symptoms due to
deficiency of sexual hormone.
usually occurring in women ageing
from 45 to 55.
Perimenopausal syndrome
Menopause affects the women who suffer from
it as well as their loved ones!

8. 
Derived from the Greek words for
“month” (men) and “cessation” (pausis)
A natural event in a woman's life - this
is a time of change
Menopause

9. 
 ‘Menopause’ refers to the stage in a woman’s life when
her periods cease
 Menopause occurs when the ovaries stop producing the
hormones oestrogen and progesterone
 Usually occurs between ages of 45 and 55 years
 Symptoms such as hot flushes, mood swings, tiredness,
loss of libido and irregular bleeding are common
What is menopause?

10. 
Natural
Surgical
Premature
Post-chemotherapy/radiation
cancer
Menopause: Etiology
♠cyst ,EMs
♠cancer
♠<40ys

11. 
Vasomotor symptoms : hot flashes,
night sweats
Vaginal dryness :painful intercourse,
Vulvae pruritus
Insomnia
Weight gain
Sexual changes
Irregular menses
Moon changes: Irritability, depression
Signs and Symptoms

12. 
Osteoporosis
Cardiovascular risk
Breast Disease
Diet modification
Exercise
Calcium intake, Vitamin D
Family history
Health Issues:

13. 
 Permanent cessation of menstruation which occurs
when the ovaries stop producing the hormones
oestrogen and progesterone
 Natural menopause is recognised to have occurred
once a period of 12-months has lapsed after the last
menstrual period, and for which there is no other
obvious cause
 No specific indication marks the beginning of
menopause other than the onset of symptoms

14. 
Post-menopause
When one year has lapsed since the
last menstrual period
Some women may still continue to
experience menopausal symptoms for
several years following their last period

15. 
 Issues for primary care physicians and
gynecologists:
 Hormonal changes
 Cardiovascular disease
 Osteoporosis
 Post menopausal bleeding (PMB)
 Abnormal PAP’s
 Sexual Function
 Depression
 Cancer screening and prevention
 Lifestyle and habits
Post menopause

16. 
Is hormone replacement therapy (HRT)
safe?
What can I do about my lack of sex
drive?
Commonly–Asked
Questions

17.  Combination of estrogen, progesterone and sometimes testosterone
 Estrogen is given for relief of hot flashes, night sweats and vaginal dryness
 Other advantages of estrogen:
 Improvement of sexual functioning
 Improvement with sleep
 Improvement with cognition
 Improvement of mood
 Prevents osteoporosis
 Decreases risk of fractures
 Decreases risk of colon and rectal cancer
What is HRT?

18. 
Progesterone is given with estrogen to
prevent cancer and hyperplasia (pre-
cancer) of the lining in the uterus
(endometrium)
Estrogen alone is generally given to
those women who don’t have a uterus
Testosterone is given to improve sexual
dysfunction
What is HRT?

19. 
Disadvantages of estrogen - based on the
WHI study (Women’s Health Initiative)
Coronary heart disease
Stroke
Venous Thromboembolism - clotting
that occurs in the deep veins (usually
the legs, pelvis or lungs)
Breast cancer
Endometrial cancer and hyperplasia
(known)
Is HRT Safe?

20. 
Mission: does Prempro (combo of
premarin and provera) or premarin
alone reduce cardiovascular risk
(premarin is a conjugated estrogen
and provera is medroxyprogesterone
acetate)
WHI Study

21. 
Results:
Prempro trial was halted prematurely
after only 5.2 years due to the
increased risk of CHD, stroke, VTE, and
breast cancer
Premarin-alone trial was halted
prematurely due to the increased risk of
stroke
Due to these findings the number of HRT
prescriptions dropped by 50% from 1995
to 2003
WHI Study

22. The Headlines
41% increase in
strokes
29% increase in
heart attacks
Greater than 100%
increase in VTE
22% increase in total
CVD
26% increase in
breast cancer
WHI Study
♠ 37% decrease in
colorectal cancer
♠ 33% decrease in hip
fracture
♠ 24% decrease in total
fractures

23. 
Not in the media about WHI
Average age was 63
Only 16% were within 5 years of their
last menses
Most were an average of 12 years after
their last menses
Most already had silent CVD
50% current or former smokers
Average Body Mass Index 28.5, many
obese
Average participant was older,
overweight smoker

24.  HRT is safer for younger menopausal women
 HRT is intended for relief of vasomotor
symptoms only (hot flashes, night sweats,
vaginal dryness)
 Flushing is worse between the transition
from pre-menopause to perimenopause
 Vaginal dryness, sweating, insomnia is
most prominent during the transition from
perimenopause to post-menopause
 WHI study tested only premarin and provera
 Many other forms of estrogen and
progesterone
Is HRT Safe?
Take Home Message

25. 
Definition:
decreased interest in sexual activity or
lack of sexual satisfaction.
40% of women between ages 18 to 59
report some sort of sexual dysfunction.
Sexual functioning is a very important part
of a woman’s relationship with her partner.
Sexual dysfunction is very common during
the perimenopausal and post-menopausal
years.
What can I do about
my lack of sex drive?

26. 
Causes:
Chronic disease
Medications
Psychological causes
Socio-cultural causes
Loss of estrogen
Loss of testosterone
Sexual Dysfunction

27. 
Medical problems as a cause for decreased
sexual activity
Endocrine disorders – diabetes, kidney
disease
Vascular diseases
Atherosclerosis
Neurologic disorders or injuries
Alcohol or substance abuse
Removal of the ovaries
Sexual Dysfunction

28.  The number of women aged 50 and above is increasing as
life expectancy rises
 Women can now expect to live greater portions of their lives
postmenopausal
 Proactively managing menopause is an opportunity for
women to prevent disease and improve their long-term
health and quality of life
 Menopause is a perfect time to evaluate your life and make
changes to ensure that you stay fit and healthy now and in
the future
Snapshot

29. 
 Treatment: counseling, anti-depressants,
tranquilizers, ERT: estrone (Ogen); 17-beta estradiol
(oral: Estrace; transdermals: Estraderm, Climara;
vaginal: Estring) estriol: has to be compounded;
conjugated estrogen (Premarin, similar to 17-beta
estradiol, may increase blood pressure)
Menopause Western Overview

30. 
Progesterone: acts on osteoblasts:
medroxyprogesterone (Provera),
progesterone USP (Prometrium,
Crinone); testosterone
Natural Treatment: natural OTC
estrogen & progesterone creams, bi-est
(estradiol/estriol mix), tri-est (80 %
estriol, 10 % estrone, 10 % estradiol),
DHEA
Menopause Western Overview

31. Collecting the information
from the patient
Questioning (history), Inspection (visual, tongue),
Listening & Smelling (voice, breathing, odors),
Palpation (pulse, relevant)
 Disease & their energetic imbalances are
classified into an Oriental medical diagnostic
pattern of disharmony (Bian Zheng Lun Zhi).
 Treatment focuses on correcting patterns of
disharmony by controlling and regulating the flow
and balance of energy to create homeostasis.

32. 
However, we now know that hormone
replacement therapy carries significant
risks, so many women and their
families need safe, long-term strategies
to treat menopausal symptoms.
Traditional Chinese medicine has kept
women healthy for centuries and
provides a viable solution to this
problem.
HRT&TCM

33. Western doctors traditionally prescribed hormones
to replace a woman’s own diminishing production.
Since the Women’s Health Initiative ended early in
2002, however, research has shown that this
strategy is fraught with side effects. This major
long-term study on hormone replacement therapy
found that health risks include greater incidence of
ovarian cancer, stroke, and breast cancer rates—
especially for women who take hormones for 15
years or more.
HRT & RISKS

34. Ginseng, there are more than
fifty different chemicals in it.
When a traditional Chinese
Doctor prescribes a specific
herb, he is not depending on
active Chemical ingredients
And attempting to correct a
chemical abnormality, He
based on a complex Set of
rule which govern balance in
the human body and trying
restore the harmonious flow of Qi., It
developed 2500 years ago, Before
chemistry as we know it was described

35. Moreover, key diet and lifestyle changes figure
importantly in long-term menopause management.
Specific exercises and relaxation practices help
reduce symptoms both in the short- and long-term.
Personalized dietary plans present another
effective tool, especially when created by a health
professional who understands your particular
medical history and symptom picture. Point in fact:
those cultures with vegetable and fish-based diets
like the Japanese do not technically have a word
for menopause, because the incidence of
symptoms is so low.
DIET AND LIFESTYLE

36. 
This isn’t a ‘one size fits all’ situation!
All women are different and will need
different ways to manage their
menopause
THANK YOU!! And REMEMBER!!