This document discusses the physiological changes during middle adulthood, focusing on hormonal and metabolic changes, particularly in relation to menopause in women and climacteric changes in men. It covers symptoms, management strategies for menopausal symptoms, various hormone replacement therapies, and their side effects. Additionally, it emphasizes the importance of maintaining a healthy lifestyle during this transitional period.

1. UNIT 5.2
PHYSIOLOGICAL CONCEPTS AND
PHYSICAL CHARACTERISTICS
Prepared by:
Arpana Bhusal
BNS

2. Physiologic concepts of middle
adulthood
• The growth cycle continues with physical and
physiological changes in the middle
adulthood. The body organs and their
physiologic functions vary at different rates.
The major physiologic changes occurring
during middle age are given below:
• Hormonal Changes
• Metabolic Changes
• Other Changes

3. Hormonal changes
• The endocrine system is made up of organs
and tissues that produce hormones.
Hormones are natural chemicals produced in
one location, released into the bloodstream
then used by other target organs and systems.
• Blood levels of some hormones increase,
some decrease, and some are unchanged.

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• Hormones are also broken down (metabolized) more
slowly. Many of the organs that produce hormones are
controlled by other hormones. Aging also changes this
process. For example, an endocrine tissue may produce
less of its hormone than it did at a younger age, or it
may produce the same amount at a slower rate.
• This era of life is known as the menopause period for
the female and the climacteric changes for either
gender. Cessation of estrogens and Progesterone
production by the ovaries usually occurs in 45-55 years.

5. Hormonal Changes in female:
• Irregular menstrual period, heavy vaginal
bleeding followed by amenorrhoea for 1-2 years
• Decline in production of neurotransmitters that
stimulate hypothalamus to signal pituitary to
release sex hormones.
• Pituitary continues to produce follicular
stimulating hormone and luteinizing hormone
but aging ovary incapable of responding to its
stimulation.

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• Less estrogen synthesized, no estrogen
production from ovaries.
• Aging oocytes destroy necessary genetic
material for reproduction.
• Uterine changes make implantation of
blastocyte unlikely.

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• Gradual atropy of tissues.
• Uterus and cervix become smaller
• Vulvar epithelium thins
• Labia majora and minora flatten

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• Vaginal mucosal lining thinner, drier, pale
• Natural lubrication during intercourse decreases.
• Neuroendocrine symptoms appear e.g. hot
flashes, night sweats followed by chilling, fatigue,
nausea, dizziness, headache, palpitations and
paresthesias.
• Emotional liability

9. Hormonal changes in male
• Testosterone production gradually decreases
which eventually causes:
• Degeneration of cells in tubules
• Production of fewer sperms

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• More time needed to achieve erection
• Less forceful ejaculation
• Testes less firm and smaller

11. MENOPAUSE
• Menopause is the permanent cessation of
menstruation preceded by gradually
decreasing of menstrual flow.
• Woman is in menopause when she has not
had a menstruation period for one year.
• The ovarian failure, with hormone deficiency
is the cause of various physical and
psychological symptoms, such as hot flashes,
vaginal atrophy and depression.

12. Management of menopausal
symptoms
• Increasing physical activity and exercise.
• Eating a low fat, high-fiber diet.
• Keeping blood sugar, cholesterol and triglyceride levels
within healthy limits.
• Smoking cessation and limiting alcohol intake.
• Maintaining normal weight and blood pressure.

13. PERIMENOPAUSAL PERIOD
• This is a time of gradual diminution of ovarian
function and a gradual change in endocrine
status.
• Peri-menopausal period remains about 5 years.
Vasomotor changes occur and which may lead to
hot flushes associated with chilly sensation,
dizziness, headache, palpitation, nausea, muscle
cramp, insomnia, paresthesia of finger and toes.
• The hormonal decline causes additional
symptoms such as:

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• Skin, subcutaneous tissue and mucous
membrane become atrophy and dry.
• Loss of skin turgor, loss of tone results wrinkles.
• Loss of muscle tone in pelvic floor, urethra,
sphincter it may leads urgency of urination,
incontinence.
• Uterus, ovary, breast become atrophy.

15. CLIMACTERIC CHANGES
• The climacteric is the period in life when
important physiologic changes occur, with the
cessation of the female`s reproductive ability
and the period of lessening sexual activity in
male.
• A few complain of hot flushes, sweating and
sometime chills and dizziness, headache and
palpitation occurs due to changes of hormone.

16. Climacteric changes in female
• Loss of elasticity to vaginal mucosa which may lead to
dyspareunia.
• All menopausal women abnormal bleeding or spotting
after 12 months indicate high risk of cancer.
• Regular sexual activity helps to maintain adequate
outlet and to prevent shrinkage of vaginal mucosa.

17. Climacteric changes in Male
• Decreasing level of testosterone, reduced amount
of viable sperm, some decline in sexual energy
and slowing of erection response. Men do not
loose reproductive ability but likelihood to
reduction.
• The sex hormone does not stop but merely
reduce. Testes become less firm and smaller, cells
in the tubules degenerate, sperm production
decreases.

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• Decrease testosterone production leads to
longer time of erection and may less forceful
ejaculation. Men with high stress are lead to
depression, low self esteem due to their
physiological or hormonal changes.

19. HORMONAL REPLACEMENT THERAPY
• Estrogens replacement therapy is commenced
on the basis of dependent or previously
estrogen sensitive women.
• Low dose estrogens for short period to
improve metabolic state. Estrogens therapy
relieves unpleasant symptoms such as hot
flashes and vaginal dryness and also appeared
to protect against postmenopausal conditions
such as osteoporosis and heart disease

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• Long term use may predispose to
endometrium cancer, breast cancer, high
blood pressure, MI, cerebral vascular accident
(CVA).
• All women receiving estrogens replacement
therapy should perform six monthly Pap test,
Breast Self Examination and blood pressure
routinely.

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• Testosterone replacement therapy in male is
provided if symptoms of low testosterone.
Symptoms include:
• Libido
• Erectile dysfunction
• Fatigue and poor energy level
• Decreased muscle mass

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• Body and facial hair loss
• Difficulty concentrating
• Depression
• Irritability
• Low sense of well-being

23. Administrations and Formulations of
Hormone Replacement Therapy
• Hormonal replacement therapy is given as a
short term relief from menopausal
symptoms.(often one or two years, usually
less than five)

24. Estrogen Therapy
Oral tablets
• commonly given in amounts of 1 to 2
milligrams of estradiol per day.
E.g.Cenestin, Estrace, Estratab, Femtrace,
Ogen, and Premarin

25. Estrogen patches
• applied twice weekly or weekly depending on
brand, to fatty areas of skin which crease less,
preferably the lower abdomen or buttocks
amd never to breasts. The estrogen progestin
patch is worn 14 days in 28 day cycle.
Examples are Alora, Climara, Estraderm,
and Vivelle-Dot

26. Topical Estrogen
• Creams, gels and sprays offer other ways of
getting estrogen into your system.
• Examples include gels (like Estroge and Divigell),
creams (like Estrasorb), and sprays (like Evamist).
As with patches, this type of estrogen treatment
is absorbed through the skin directly into the
bloodstream.
• The specifics on how to apply these creams vary,
although they're usually used once a day.
• Estrogel is applied on one arm, from the wrist to
the shoulder. Estrasorb is applied to the legs.
Evamist is applied to the arm.

27. Vaginal estrogen
• Vaginal estrogen comes in a cream, vaginal ring, or vaginal estrogen
tablets.
• In general, these treatments are for women who are troubled specifically
by vaginal dryness, itchiness, and burning or pain during intercourse.
• Examples are vaginal tablets (Vagifem), creams (Estrace or Premarin), and
insertable rings (Estring or Femring).
• Dosing schedules vary, depending on the product. Most vaginal rings need
to be replaced every three months.
• Vaginal tablets are often used daily for a couple of weeks; after that, you
only need to use them twice a week.
• Creams might be used daily, several times a week, or according to a
different schedule.

28. Estrogen transdermal gels
• by patch or needles

29. Testosterone Replacement Therapy
• Skin patch: androderm is a skin patch worn on
the arm or upper body applied once a day.
• Gels: AndroGel and Testim are clear
testosterone gel are applied directly to skin
once a day.

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• Mouth patch: Striant is a tablet that sticks to
the upper gums above the incisor which is
applied twice a day.
• Injections and implants: can be applied in
muscles and soft tissues.

31. Estrogen and progesterone/progestin
Replacement therapy
• This is often called combination therapy, since it
combines doses of estrogen and progestin, the
synthetic form of progesterone.
• It’s meant for women who still have their uterus.
• Taking estrogen with progesterone lowers your
risk for cancer of the endometrium, the lining of
the uterus.
• While generally used as a form of birth control.
Progesterone can help treat many menopausal
symptoms such as hot flashes

32. Oral progestins
• Taken in pill form, progestin medications
include medroxyprogesterone acetate (Provera) and
the synthetic progestin pills
(norethindrone, norgestrel).
• Many experts now treat the majority of
their menopausal patients with natural progesterone
rather than synthetic progestins.
• Natural progesterone has no negative effect on lipids
and is a good choice for women with high cholesterol
levels.
• In addition, natural progesterone might have other
advantages when compared with
medroxyprogesterone acetate.

33. Intrauterine progestin
• The low-dose intrauterine devices (IUD)
levonorgestrel are sold under the brand
names: Liletta, Kyleena, Mirena and Skyla.

34. Combination estrogen
and progestin patches
• Climara Pro and Combipatch are also
available.
• Menostar has a lower dose of estrogen than
other patches, and it's only used for reducing
the risk of osteoporosis.
• It doesn't help with other menopause
symptoms.

35. Side effects of
Hormone Replacement Therapy
• Nausea
• Bloating
• Indigestion
• Headache
• Mood swings
• Depression

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• Acne
• Back pain
• Leg cramps
• Uterine Bleeding
• Breast Tenderness

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• Swelling
• False positive results on mammogram due to
increased breast tissue density.
• Testosterone therapy in male can cause
increase libido, muscle mass and strength but
also increase the risk for prostatic hypertrophy
and cancer and diabetes.
• Increased risk of stroke

38. Management of Hormone
Replacement Therapy
Assessment:
• Any contraindications before prescription
• Dose and duration
• Side effects of therapy

39. Intervention
• Increasing physical activity and exercise
• Nutrition: a low fat and high fiber diet
• Maintaining blood sugar, blood cholesterol and
triglyceride levels within healthy limits.
• Smoking cessation and limiting alcohol intake.

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• Maintaining normal weight and blood
pressure
• Calcium and vitamin D supplementation for
prevention of osteoporosis.
• Health teaching on side effects and duration
of therapy.

42. REFERENCES
• Sharma M, Poudel K, Gautam R, (2015) Essential Textbook
Of Medical surgical Nursing, 1st edition, Samikshya
Publication Pvt. Ltd.
• Thapa U,(2010) A text book of Common Health Problems Of
Adulthood, 1st edition, Makalu Publication House
• Murray RB, Zentner JP, Yakimo R, Health Promotion
Strategies Through the Life Span, 8th edition
• www.monstercrawler.com/ retrieved on 2075-01-18
• https://www.sharecare.com/health/endocrine-
system/how-hormone-levels-change-age
• retrieved on 2075-01-18
• https://www.webmd.com/menopause/guide/menopause-
hormone-therapy retrieved on 2075-01- 18
• https://medlineplus.gov/hormonereplacementtherapy.htm
l retrieved on 2075- 01- 18