Menopause typically occurs between ages 49-52 as the ovaries gradually slow production of eggs and reproductive hormones, causing menstrual periods to stop. It may be induced by surgery or occur prematurely under age 40. Symptoms include hot flashes, mood changes, and increased risk of osteoporosis and heart disease due to hormonal changes. Hormone replacement therapy can help treat symptoms but also carries risks if used long term. Maintaining a healthy lifestyle through diet, exercise, avoiding smoking and limiting alcohol can also help manage menopausal effects.

1. PRESENTATION TOPIC : MENOPAUSE

2. DEFINITION : Greek word pausis ("pause") and mēn
("month").
Menopause, also known as the climacteric, is the time
in most women's lives when menstrual periods stop
permanently, and they are no longer able to bear
children.
Menopause typically occurs between 49 and 52 years
of age

3.  1) Age is the leading cause of menopause. It's
the end of a woman's childbearing years,
brought on by the ovaries gradually slowing
down.

4.  On average, women are 51 at natural menopause,
notes the National Institute on Aging. But
menopause can start earlier or later. A few women
start menopause as young as 40, and a very small
percentage as late as 60. Women who smoke tend to
go through menopause a few years earlier than non
smokers.
 There is no proven way to predict menopause age.
It's only after a woman has missed her periods for
12 straight months, without other obvious causes,
that menopause can be confirmed.

5.  2)Premature ovarian failure
 Premature ovarian failure (POF) is the cessation of the
ovarian function before the age of 40 years.
 It is diagnosed or confirmed by high blood levels of
follicle stimulating hormone (FSH) and luteinizing
hormone (LH) on at least three occasions at least four
weeks apart.
 Known causes of premature ovarian failure include
autoimmune disorders, thyroid disease, diabetes
mellitus, chemotherapy, being a carrier of the fragile X
syndrome gene, and radiotherapy. about 50–80% of
spontaneous cases of premature ovarian failure, the
cause is unknown, i.e., it is generally idiopathic.

6.  Menopause can be surgically induced by
(removal of ovaries), and uterus
(hysterectomy).Cessation of menses as a
result of removal of the ovaries is called
"surgical menopause".

7.  Includes
 Natural decline of reproductive hormones.
 Chemotherapy and radiation therapy.

9.  Premature menopause : A woman's ovaries
stop working at a very early age, ranging
anywhere from the age of puberty to age 40,
and this is known as premature ovarian
failure (POF).
 Delayed menopause : if the menopause fail
to occur even beyond 55 years it is called
delayed.

10.  Peri-menopause : perimenopause is technically
defined as the time from which menses start to
become irregular and FSH levels have increased,
until the time when it is known that periods have
ceased completely.
 Pre-menopause :Premenopause is a word used to
describe the years leading up to the last period,
when the levels of reproductive hormones are
already becoming lower and more erratic, and the
effects of hormone withdrawal may be present.
 Post menopause : The term post menopause is
applied to women who have not experienced a
menstrual bleed for a minimum of 12 months.

12.  Hot flashes : brief feeling of heat that may make
the face and neck flushed and cause temporary
red blotches to appear on the chest, back, and
arms. Sweating and chills may follow. Hot
flashes vary in intensity and typically last
between 30 seconds and 10 minutes.
 solution
 Dressing in light layers, using a fan, getting
regular exercise, avoiding spicy foods and heat,
and managing stress may help you deal with
hot flashes.

13.  Dyspareunia or painful intercourse
 Decreased libido
 Problems reaching orgasm
 .

14.  Depression , Anxiety , Fatigue , Irritability
Memory loss and problems with concentration
Mood disturbance : specially mood swing is
common.
 Sleep disturbances
 Insomnia , Sleepiness , Aggressiveness ,
Tension ,Phobias , Low self-esteem ,Tearfulness

15.  1. Hormonal changes
 2. Sleeplessness
 3. Stress
 4. sexual dysfunction
 5. changes in the body and negative attitude
towards aging

16.  1. Back pain
 2. Joint pain, Muscle pain
 3. Osteopenia and the risk of osteoporosis
gradually developing over time

17.  Risk of Ischemic heart disease.
 Coronary artery disease and stoke increased.
 Atherosclerotic changes .
 Vasoconstriction .
 Thrombus formation

18.  Breast atrophy .
 breast tenderness +/- swelling .
 Decreased elasticity of the skin .
 Formication (itching, tingling, burning, pins
and needles, or sensation of ants crawling on or
under the skin) .
 Skin thinning and becoming drier

19.  Cessation of menstruation for consecutive 12
months during climacteric.
 Appearance of menopausal symptoms ‘hot
flush’ and ‘night sweats’.
 Vaginal cytology – showing menstruation
index of at least 10/85/5 (features of low
oestrogen).
 Serum oestradiol : < 20 pg/ml.
 Serum FSH and LH: 40 mlU/ml (three values
at weeks interval required.

20.  Prevention
 Counselling
 Treatment

21.  hormone replacement therapy (HRT) :-is
the use of estrogen in women without a uterus
and estrogen plus progestin in women who
have an intact uterus.
 HRT may be reasonable for the treatment of
menopausal symptoms, such as hot flashes.
 It is the most effective treatment option,
especially when delivered as a skin patch.

22.  The HRT is indicated in menopausal woman to
overcome the short term and long term
consequence of oestrogen deficiency.
 Indications of hormonal replacement therapy:
 1. Relief of menopausal symptoms
 2. Prevention of osteoporosis
 3. To maintain the quality of life in
menopausal years

24.  Special group of woman to whom HRT should
be prescribed:
 1. Premature ovarian failure
 2. Gonadal dysgenesis
 3. Surgical or radiation menopause

25.  Endometrial cancer , Venous thromboembolic
disease: , Increased risk within 1-2 years after
initiation of hormone therapy.
 Breast cancer ,Increased breast density with
progestogens via proliferation of estrogen-
dependent mammary tissue, making it more
difficult to detect breast cancer early with a
mammogram , Family history
 Duration of exposure Ovarian cancer >10
years estrogen therapy
 Cerebrovascular accidents

26.  1. Undiagnosed genital tract bleeding
 2. Oestrogen dependent neoplasm in the body
3. History of venous thromboembolism
 4. Active liver disease
 5. Gallbladder disease

27.  Nutritious diet
 Supplementary calcium – daily intake of 1-
1.5 gm
 Exercise – weight bearing exercises,
walking, jogging.
 Vitamin D – supplementation of vitamin D3
(400-800 IU/day) along with calcium can
reduce osteoporosis and fractures.
 Cessation of smoking and alcohol.

28.  There is no evidence of consistent benefit of
alternative therapies for menopausal
symptoms despite their popularity.
 Evidence does not support a benefit from
phytoestrogens such as coumestrol,
femarelle,or the non-phytoestrogen black
cohoshThere is no evidence to support the
efficacy of acupuncture as a management for
menopausal symptoms

31.  1. The age when women are likely to enter
menopause is usually
 A. 35 - 40 years
 B. 40 - 45 years
 C. 45 - 50 years
 D. None of the above

32.  4. Symptoms of menopause include
 A. Hot flushes
 B. Loss of sex drive
 C. Mood swings
 D. All of the above

33.  5. The following helps to control the symptoms
of menopause
 A. Diet and exercises
 B. Medication
 C. Lifestyle changes
 D. All of the above

34. Thanks