The document discusses physiological and non-physiological menopause. Physiological menopause typically occurs between ages 51-52 and is diagnosed clinically based on symptoms. Tests are not useful during perimenopause due to hormonal variations. Non-physiological menopause can be premature before age 40, or iatrogenic due to medical treatments like chemotherapy or drugs that induce temporary menopause. Surgical menopause results from bilateral oophorectomy. Menopause affects women through vasomotor symptoms, psychological effects, changes to the endometrium and urogenital tract, impacts on bone health, and increased risk of conditions like dementia. Lifestyle and diet, pharmacological treatments, and hormonal replacement therapy

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. 