Menopause is defined as the cessation of the menstrual period and marks the transition from reproductive capability, typically occurring during the climacteric phase that can last up to 15 years. Causes include ovarian aging and pathologically induced menopause, leading to various symptoms like menstrual irregularities, hot flushes, and long-term health risks such as osteoporosis and cardiovascular disease. Management involves diagnosis, treatment options including hormonal replacement therapy, and support to maintain a woman’s vitality and quality of life.

1. By Dr Kihara

2. Definition: is the cessation of the menstrual period. It
heralds the transition from reproductive capability to
incapability.
The premenopausal period to the postmenopausal
period is termed as CLIMACTERIC and can last up to
15 years.

3. Causes of menopause
1. Physiological ageing of the ovaries
2. Pathologically induced menopause
 Premature ovarian failure
 Radiation
 Cytotoxic therapy
 Bilateral oophorectomy

4. Physiology of menopause
Hypothalamic pituitary ovarian axis elaborated.
With the aging of the ovaries there is reduction in the
production of the sex steroids principally estrogen and
the following occurs:

5. 1. Menstrual irregularities due to anovulation.
2. Changes in the circulating levels of sex steroids,
inhibin and pituitary gonadotrophins.
3. Decrease in the fertility rates.
4. Neuroendocrine changes of thermoregulation,
sleep patterns, mood and behavior (vasomotor
effects).
5. Eventually the cessation of menstruation and the
clinical effects of dwindling sex steroids.

6. Clinical picture of the climacteric
Problems associated with estrogen deficiency
Stage I
Changes in the menstrual cycle
Hot flushes
Night sweats
Insomnia
Depression
Mood changes

7. Stage II – Intermediate
Urogenital atrophy
Dyspareunia ( painful/ difficult sexual intercourse)
Dysuria (painful/ difficult urination)
Stress incontinence
Skin changes

8. Stage III – Late
Osteoporosis
Cardiovascular disease
Alzheimer's disease

9. Management
 History
 Physical examination
 Baseline investigations
 Diagnosis
 Treatment – The essence of a woman’s vitality and
wellness must be maintained.
Ensure that you r/o malignancies

10. 1. Relieve early symptoms.
2. Reduce intermediate and long term consequences.
3. Enhance vitality and quality of life.

11. Options to treatment
1. Reassurance
2. Hormonal replacement therapy
This should be guided by the presence of the uterus
+/- cyclical bleeding, Absence of the uterus and
the ovaries
3. Presence of sexual dysfunctions and treatment
4. Adjuvant therapy – Nutrition, vitamin
supplements and herbal therapy, exercise
5.Support from partner, the family members and
community.