Menopause

2. 
 The average age of the menopause worldwide is at a median
age between 51 and 52 years.
 Endocrine changes
Physiological Menopause

3. 
 The diagnosis of menopause is a largely clinical diagnosis that
is made according to symptoms experienced.
 The use of serum endocrine tests are of little value in the
perimenopausal years as they are unpredictable due to the
hormonal variations.
Physiological Menopause

4. 
 Premature Ovarian Insufficiency
- if menopause occurs before the age of 40 years it is defined as
premature ovarian insufficiency (POI
- While no cause is found in most cases of primary POI, a
suspected case should be investigated
Non-physiological menopause

5. 
 Iatrogenic menopause – medical treatments and menopause
after cancer treatment
- Drugs that are GnRH agonists (e.g. buserelin and goserelin)
- When administered continuously will down-regulate the
pituitary and decrease LH and FSH secretion
- This will induce a temporary menopause with a relatively rapid
onset.
Non-physiological menopause

6. 
 Iatrogenic menopause – surgical menopause
- Bilateral salpingo-oophorectomy
- It is important during preparation that they are aware that as
well as losing oestrogen they will also lose the effect of
testosterone.
Non-physiological menopause

7. 
 Vasomotor symptoms
How women are affected by the
menopause

8. 
 Psychological symptoms
- depression
- low mood
- irritability
- lack of energy and tiredness
- acceleration of the onset or incidence of dementia
How women are affected by the
menopause

9. 
 Endometrial effects
- The initial irregular or scanty vaginal bleeding is due to the reduction
in estrogenic endometrial stimulation.
 The urogenital tract and vulvovaginal atrophy
- vaginal dryness, irritation, burning, soreness and dyspareunia.
- Loss of the estrogenic support to the vaginal epithelium leads to
reduced cellular turnover and reduced glandular activity
- Incontinence and prolapse worsen during the menopause
How women are affected by the
menopause

10. 
 Bone health
- There is a steady decline until the menopause, then an accelerated
phase of bone loss until 60 years, followed by further steady
decline until death
How women are affected by the
menopause

11. 
 Diet and lifestyle
Management

12. 
 pharmacological
Management

13. 
 Hormonal replacement therapy (HRT)
 If estrogen is given without progestogenic opposition, there is a risk
that in time endometrial hyperplasia and cancer may develop.
 Systemic estrogen-only HRT is suitable for women following a
hysterectomy
 The administration of progestogen is necessary to protect the
endometrium.
 This results in regular monthly menstruation.
Management

14. 
Beneficial effects of hormone
therapy

15. 