lj;jl;jl;jl;j;lj;lj;l

2. After this presentation, participants shall be able to:
 Define Menopause and its transitional stages.
 Identify risk factors related to Menopause.
 Enumerate its signs and symptoms.
 Identify treatments and its management related to
nursing.
After this presentation, participants shall be able to:
 Define Menopause and its transitional stages.
 Identify risk factors related to Menopause.
 Enumerate its signs and symptoms.
 Identify treatments and its management related to
nursing.

3.  Menopause is the cessation
of a woman's reproductive
ability, the opposite of
menarche. varies greatly
from person to person.
Introduction

4. 
Definition




 Menopause is the physiological and
permanent cessation of menstruation due to
failure of ovarian function.
 Menopause is diagnosed when
menstruation has ceased for at least 6 up to
12 months in a woman above the age of 40
and in absence of any pathogenic cause.
 Menopause is a manifestation of the
climectric which is a transitional phase
lasting about 5 years before and after
menopause (including perimenopause,
menopause, post menopause)

5. Menopause
• Menopause Age
• Median - 51.4, range of 48-55 yrs
• Median for perimenopause - 47.5 years, median length
of 4 years
• Premature menopause -caused by genetic abnormalities
on the long and short arm of X chromosome
• Earlier menopause:
– surgical causation (30%)
– family history of early menopause
– cigarette smoking, blindness
– abnormal chromosome karyotype
– precocious puberty
– left-handedness
• Later age :
– obesity
– higher socioeconomic class

6. Ovaries becomes
unresponsive to the
FSH
FSH increase to
stimulate ovaries
Estrogen decrease as
fewer follicles mature
Irregular menstrual
period
Corpus Luteum is
produced in varying
amounts
Progesterone levels
fluctuate

7. Ovaries continuously becomes
unresponsive to the FSH
Fewer and fewer follicles are recruited until
no follicles develop at all
FSH and LH levels become persistently
elevated
sharp fall in estrogen Amenorrhea

8. Ovarian Dysfunction
Women are born with about 1.5 million
ova
At menarche ↓400,000 ova
Most women menstruate about 400
times between menarche & menopause
With menopause, the ovary is no longer
capable of responding to pituitary
gonadotropins →↓ production of
estrogen &progesterone

11. Types of Menopause :
Normal or natural Menopause :
Occurring between the age of 40 and 55 years with an average of 50 years
2 Premature menopause :
Menstruation ceases before the age of 40. it occurs in about 1% of women below the
age of 40.
3 Delayed menopause :
Menstruation continues after the age of 55 . The cause are
(a)Constitutional (familiar or racial)
(b)Uterine fibroids .
(c)Diabetes mellitus, and. oestrogenic ovarintumors.
4 Artificial menopause:
Caused by surgical removal of both ovaries or their destruction by radium or deep
X-ray therapy

14. GENERAL
 Vasomotor symptoms( Hot flashes (aka hot flushes),
 Recurrent, transient episodes of flushing accompanied
by a sensation of warmth to intense heat sensation in chest,
neck , face, and head and may spread allover the body,
followed by cold flush) .dis appear after 2 years without
treatment.
 A trophy of glandular tissue of breast
 Gastro intestinal change decrease appetite or increase
leading to obesity. dyspepsia
 Tendency to develop menopausal hypertension a estrogen
protects against athero sclerosis.
 The level of cholesterol rise and risk of coronary heart

15. 


- Public hair becomes scantly, grey or white in color.
- Atrophy of vulva with loss of subcutaneous fat.
- The vagina become narrow, smooth, thin with little
or no glycogen.
- The vaginal acidity is reduced PH become alkaline.
this predispose for infection.
- The uterus becomes small and atrophic
- The ovaries become small and fibrotic
- genital prolapse. Due to atrophic cervical ligaments
-Atrophy of bladder and urethral mucosa this lead to
-urgency, incontinence and recurrent attacks of
cystitis and urethritis




Local changes

16. Hormonal Changes :
-Oestrogen level is low due to absence of ovarian follicles.
-Increase in the level of follicles stimulating hormone (FSH) and
luteinizing hormone (L.H).
-Metabolic :
-Obesity, osteoporosis, joint pain and back ache and decreased
muscle strength
-sexual.
-Libido is unchanged in most cases but may increase or decrease

18.  Depression and/or anxiety
 Irritability
 Memory loss, and problems with
concentration
 Mood disturbance
 Sleep disturbances, poor or light sleep,
insomnia, and daytime sleepiness

19. Cardiovascular system changes
Genitourinary system changes
 Osteoporosis
Weight Gain
Sexual dysfunction

20. Cardiovascular system
changes
• Leading cause of death - twice as many women die
of cardiovascular disease than of cancer
• Incidence rates of coronary heart disease in both
men and women were similar 6-10 years after the
menopause
• Serum cholesterol increases significantly at 1-2
yrs or more after the menopause - marked by an
increase in triglycerides, an increase in LDL,
decrease in HDL - and are less cardio protective

21. • Atrophy of vaginal epithelium -> atrophic vaginitis (itching,
burning, discomfort, dyspareunia and vaginal bleeding)
• Urologic: 30% drop in urethral closure pressure at rest and
during stress in postmenopausal women because of atrophy of
the urethral mucosa, varying degrees of bladder and urethral
prolapsed and loss of UV angle
• Atrophic urethritis -> urgency, frequency, dysuria, suprapubic
pain, ø UTI
• Atrophic cystitis -> urge incontinence, frequency, dysuria, and
nocturia
• Descent of uterus due to decreased collagen in uterosacral
ligaments and cardinal ligament
Genitourinary system changes

22. Menopause &Osteoporosis
• 25% of women have radiological evidence of
osteoporosis by 60; by 80Y 1 in 4 have fractured a
hip; after age 65 1 in 3 have a vertebral fracture
• 15% of women with hip fracture after age 80 will die
of complications within 6 months
• Initial period of up to 4-5 years after the menopause
there is accelerated loss of bone at rate of 1-2% per
year; trabecular bone mainly
• Bone loss is mainly in the trabecular type while
cortical type occur later .
• Three most common fractures in postmenopausal
women - vertebrae, ultra distal radius and neck of
femur

23. Menopause &osteoporosis
• Risk factors:
– white or Asian
– reduced weight for height
– early spontaneous menopause or surgical menopause
– family history of osteoporosis
– low dietary calcium intake
– low vitamin D intake
– high caffeine intake
– high alcohol intake
– high protein intake
– cigarette smoking
– endocrine disorders - diabetes mellitus,
hyperthyroidism, Cushing disease

25. eneral (explanation & reasurance avoid factors like
erveousness, hot weather, hot bath , healthy life
yle as avoid excessive coffee or tea,
ormone Therapy(HRT with estrogen )
aginal Estrogen
ow-Dose Anti Depressant
edication to prevent or treat Osteoporesis
Management

26.  Complementary and alternative
medicine
Herbal preparations
Acupuncture
Hypnosis
Yoga
Management

27.  Encouraged regular exercise.
 Encourage family members to give
emotional support to prevent depression.
 Encouraged to take healthy and balance
diet.
 Encourage to practice relaxation
techniques and get enough sleep.
Health Education

28.  Instruct to get enough calcium, Vitamin
D or minerals and supplements if
recommended by the Doctor.
 Instruct to prevent smoking.
 Instruct to wear light and comfortable
clothes.
Health Education

29. Menopause
is a natural
biological
process.
It is not a
disease to be
treated.
Let us all
remember
….