Menopause is a natural physiological process marked by the loss of ovarian function and fertility. It typically occurs between ages 48-52 and can cause various symptoms due to declining estrogen levels. Long term effects include increased risk of cardiovascular disease and osteoporosis. While hormone therapy can provide relief from symptoms, it may also increase risks for some cancers and other conditions. Careful evaluation and treatment of symptoms is important for women's health and quality of life during this transition.

4. what is menopause?
A physiological loss of ovarian hormonal activity
Closely allied to loss of reproductive potential
Permanent cessation of the primary ovarian functions

5. Physiology

6. The Ovaries
2 Functions – produce ova & secrete hormones
Start secreting estrogen & progesterone from
puberty to menopause
Most of the beneficial effects derivefrom
estrogen

8. actions of estrogen
formation of the 20 sex characteristics
develop ovaries, tubes, uterus & vagina
endometrial proliferation

9. actions of estrogen
increases fat deposition
maintain the skin & vessels
bone - increase formation & reduce resorption

10. When does menopause occur?
Tends to occur over aperiod of years
A consequence of biological ageing
Genetic & environmental factors
Asian women – 48 - 52 years

11. Types of menopause
- Late Menopause
- Surgical /Medical menopause

12. Perimenopause
-the time just before and soon after the
occurence of menopause
-symptoms of menopause have started
-not yet certain if menopause is established
yet

13. Diagnosis of menopause
The diagnosis of menopause is mainly clinical
•a. Clinical Criteria
1.age around menopause ( around 50 years )
2.no periods for 12 months
3.menopausal symptoms
•( NB. All 3 clinical criteria need not be present for a diagnosis )
•Laboratory diagnosis is generally not necessary for the diagnosis of
menopause. However, where in doubt, laboratory testing of FSH may support
the diagnosis, viz
•b. Laboratory Criterion
•1. FSH level > 35miu/ml

14. The consequences of
menopause

15. Primary Symptoms
- Menstrual changes
- Hot flashes, night sweats
- Vaginal dryness, micturition altered

18. Secondary Symptoms
Physical
-Muscle & joint pains
-Skin dryness, decreased stamina, backache
Sexual
-Decreased libido

20. Secondary Symptoms
-Avoiding intimacy
-Psychophysiologic changes
-Decrease concentration
-Depressive symptoms

22. Long term effects
Cardiovascular
Bone Cancers
Cerebrovascular Diseases

23. Minor conditions
- Urinary tract infections
- Vaginal dryness
- Vaginal infections
- Joint & muscle pains

24. Perimenopausal abnormal bleeding
- At this age, there are many conditions that peak
e.g. uterine tumors
- Cancers are always a concern

25. Perimenopausal abnormal bleeding
- Infections are the most common occurrence
- All these must be ruled out before a diagnosis of
perimenopausal bleeding is made

26. Postmenopausal bleeding
-Consider it as always abnormal
-Always think of cancer
-Usually due to atrophy or infection

27. Cardiovascular disease
CV risk increases as estrogen levels decline
1 in 2 women will die from cardiovascular disease
Estrogen exerts beneficial effects on CV system through
- Direct effect on the vasculature
- Indirect effect of lipid metabolism
,

29. Fracture Risk
decreased bone density/osteoporosis
common fractures involve hip, forearm
& spine

30. You wanna be like this?

31. Psychomotor & Mental
Loss of libido
Suicidal tendencies
Marital discord

32. Menopausal
Hormone Therapy

35. Potential risks & concerns
-Breast cancer
-Cardio vascular disease
-Venous thrombosis
-Endometrial cancer
-Compliance/therapy

36. Current Recommendations
-hormone therapy should be initiated for the
treatment of menopause-related symptoms
-the lowest dose should be used for the
lowest duration
-5 years recommended for estrogen+prog
therapy

37. Current Recommendations
- hormone therapy risks
- deep vein thrombosis & pulmonary emboli
- increased risk of breast cancer with est+prog
combination

38. - improves bowel function
- stabilizes your hormones
- assists with weight loss

39. Women are 5 x more prone to
osteoporosis.

40. - helpful for bone health
- reduces the risk of heart attacks, high
blood pressure, strokes, asthma, allergies, and
possibly breast cancer

41. - cardiovascular benefits and lowering
triglycerides
- helps preserve brain function including
cognitive delay, dementia, and Alzheimer's

42. - nutritional insurance

43. - key for body's energy transport system,
- for cardiovascular health
- helps with hot flashes, mood swings, and
depression

48. Summary

49. Menopause is a natural occurrence
It is associated with long-& short-term issues
Some of the menopausal symptoms may mimic medical disorders
The important points

50. Postmenopausal conditions such as bleeding & masses must be
seriously looked into
Hormone therapy should be used but it has its problems
The important points