Menopause is defined as the permanent cessation of menstruation and fertility, occurring naturally around age 45-55. It marks the end of the reproductive phase of a woman's life. There are typically four phases - pre-menopause, peri-menopause, menopausal, and post-menopausal. Common symptoms include hot flashes, night sweats, sleep issues, urinary problems, and mood changes. Hormone therapy can help treat symptoms but comes with some health risks, so lifestyle changes and non-hormonal options are usually recommended first.

2. INTRODUCTION
• The transition from reproductive to non-
reproductive . The word "menopause" literally
means the "end of monthly cycles" from the
Greek word pausis (cessation) and the root men-
(month).
• Menopause is an unavoidable change that every
woman will experience. The date of menopause
in human females is formally medically defined
as the time of the last menstrual period.

3. DEFINITION
• Menopause means permanent cessation of
menstruation at the end of reproductive life
due to loss of ovarian follicular activity. It is
the point of time when last and final
menstruation occurs.
• Menopause is the permanent cessation of
the primary functions of the human ovaries.

4. Age of menopause
• Age is genetically predetermined .
• Cigarette smoking and severe malnutrition
may cause early menopause.
• The age of menopause 45-55 years
• Average 50

5. PHASES OF MENOPAUSE
It have 4 phase :-
• Pre- Menopause :- Pre-menopause is broadly
defined as the entire woman’s life before
menopause. During this phase, a woman will
have regular periods, can bear children and
the sex hormones like estrogen and
progesterone retain a steady balance.

6. • Peri- Menopause :- Perimenopause can begin 8-
10 years prior to menopause with the ovaries
gradually producing less oestrogen. Generally
starting in the 40’s, it lasts until menopause. The
drop in oestrogen increases with women
experiencing many symptoms. There Is
a possibility of women getting pregnant if they
still experience the menstrual cycle . A period of
women life characterized by the physiological
changes associated with the end of reproductive
capacity and terminating with the completion of
menopause also called climacteric.

7. • Menopausal phase :- It is the end of menstruation
.the age of menopause ranges between 45-55 years .
Menopause refers to a specific period, and that is
your last period. Once you have gone through a
period of 12 consecutive months without
experiencing a menstrual cycle The ovaries stop
releasing eggs.
• Post menopausal :- It is the time after which a women
has experienced 12 consecutive month of
amenorrhea.

8. Types of Menopause
There are several types of menopause and
each depends on the cause and/or timing of
the end of menstruation.
• Natural Menopause
• Premature or Early Menopause
• Surgical or Induced Menopause

9. Etiological factor
• Natural decline of reproductive hormone.
• Hysterectomy
• Chemotherapy and radiation therapy
• Primary ovarian insufficiency
• Removal of the ovary

11. MENOPAUSAL SYMPTOMS
• VASOMOTR SYMPTOMS
• UROGENITAL ATROPHY
• OSTEOPOROSIS AND FRACTURE
• CARDIOVASCULAR DISEASE
• CEREBROVASCULAR DISEASE
• PSYHOLOGICAL CHNAGES
• SKIN AND HAIR
• SEXUAL DYSFUNCTION
• DEMENTIA AND COGNITIVE DECLINE

12. VASOMOTOR SYMPTOMS
• Hot flashes
• Night sweats
• Sleep disturbance

13. GENITOURINARY SYMPTOMS
• Atrophic changes
• Epithelium more prone to damage and infection
• Vaginal pH become alkaline and narrow interoitus
• Incontinence of urine
• Urgency
• Dysuria

14. PSYCHOLOGICAL SYMPTOMS
• Irritability
• Mood swings
• Poor memory
• Anxiety
• Headache
• Depression
• Dysphasia

15. SKIN AND HAIR SYMPTOMS
• Purse string
• Crow feet
• Loss of skin elasticity gradually
• Loss of pubic and axillary hair
• Slight baldness

16. DIAGNOSIS
• Cessation of menstrual cycle for consecutive
12 month during climacteric period
• Average age of menopause 50 years
• Appearance of menopausal symptoms
• Vaginal cytology
• Serum estradiol <20 pg/ml
• Serum FSH and LH > 40 mIU/mL

17. MANAGMENT
• Non hormonal treatment
Life style modification
Nutriticious diet
Supplementary calcium
Exercise
Vitamin D
Cessation of smoking and alcohol
Bisphosphonate
Calcitonin

18. • Selective estrogen receptors modulators
(SERM)- Raloxifenen (increase bone minerals
density)
• Clonidine to reduce hot flashes
• Paroxetine (selective serotonin reuptake
inhibitors) to reduce hot flashes
• Gabapentin is an analog of GABA, to reduce
hot flashes

19. • Phytoestrogens to reduce hot flashes
• Soy protein to reduce hot flashes
• Vit E to reduce hot flashes

20. HORMONAL THERPY
INDICATION :
• Relief of menopausal symptoms
• Relief of vasomotor symptoms
• Prevention of osteoporosis
• To maintain the quality of life in menopausal
years

21. Contraindication
Known history of breast cancer
Undiagnosed genital tract bleeding
Estrogen depending neoplasm
DVT
Active liver disease
Jaundice
Gallbladder disease
Prior endometriosis

22. RISK OF HORMONALTHERAPY
• Endometrial cancer
• Breast cancer
• Venous thromboembolic disease
• CHD
• Lipid metabolism
• Dementia has no benefits

23. MONITOR PRIOR AND DURING HRT
THERPY
• Physical examination including pelvic
examination
• Blood pressure recording
• Breast examination and mammography
• Cervical cytology
• Pelvic ultra sonography to measure endometrial
thickness
• Any irregular bleeding
• Ideal serum level of estradiol should be
100pg/ml

24. • Oral estrogen regime :-conjugated equine
estrogen (0.3 or
0.625 mg) given daily for women who have
hysterectomy
• Estrogen and cyclic progestines : for intact
uterus estrogen is continuously 25 days and
progestine for last 12-14 days

25. • Transdermal administration contain 3.2 mg
and deliver 50 ug in 24 hrs . It should be
applied below the waist line and change
twice a week
• Subdermal implants
• Percutaneous estrogen gel 1 g of gel deliver 1
mg of estradiol daily applied on to the skin
over the anterior abdominal wall or thigh

26. • Vaginal cream 1.25 mg daily
• Progestins
• levorgestrel intra uterine system
• Tibolone