Menopause-1.pptx

Menopause-1.pptx

• 1.
  MENOPAUSE Presented By: HiraAmbreen & Maryam
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  DEFINITION • MENOPAUSE isdefined as, “The woman’s final menstrual period and the accepted confirmation of this is made retrospectively after 1 year of amenorrhea”. CAUSE: cessation of regular ovarian function. PERIMENOPAUSE: The time of life from the onset of ovarian dysfunction until 1 year after the last period and the diagnosis of menopause is made.(climacteric)
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  POSTMENOPAUSAL: All the womenwho have been 1 year since their last period are deemed postmenopausal. The “CHANGE”: A colloquial discription of Perimenopause and Postmenopause.
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  TYPES • PHYSIOLOGICAL(occurring ata median age age of between 51 to 52 years). • NON PHYSIOLOGICAL (occurring before 40 years). Non-physiological 1. Premature ovarian insufficiency 2. Iatrogenic menopause Amedical treatment BSurgical menopause
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  ENDOCRINE CHANGES Menopause occursat the time of depletion of oocytes from the ovary and is irreversible. Hormonal control of menstrual cycle and hormonal disorders • GnRH(by hypothalamus) • LH and FSH(pituitary) • Inhibin(varian follicles) • Steroids  estrogen, progesterone, testosterone(ovaries, peripheral adipose tissue, adrenal gland)
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  Hormones Perimenopause Earlypostmenopause Late postmenopause GnRH Increased pulsatility Progressive decrease in pulsatility Reduction in overall levels LH&FSH Increased Increased Progressive decline Oestrogen Slight decline Rapid decline in levels Sustained very low levels Progesterone Moderate falls Unpredictable Undetectable Inhibin Slight decline Significant decline Undetectable Testosterone Progressive decline Progressive decline Sustained low levels
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  Non physiological menopause Prematureovarian insufficiency • Before 40 years • Premature ovarian failure • Supportive care counseling by Specialist unit. • Gamete donation Primary • Chromosomal Abnormalities(turne r, fragile X) • Autoimmume(hypot hyroidism, Addison, myasthenia gravis) • Enzyme deficiencies (Galactosemia, 17 @-hydroxylase deficiency Secondary Chemotherapy or radiotherapy, infections(mumps, TB, varicella, malaria).
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  Medical treatment associatedmenopause • Chemotherapy • Radiotherapy • GnRH Agonists (buserelin , goseralin ) • Backup therapy (hormones and drugs) • Surgical procedures to treat gynecological problems • Menstrual disorders, fibroid, endometriosis • BSO(Bilateral salpingoophorectomy (high risk women breast and ovarian cancer, BRCA1and 2 gene mutation screening. • planning
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  POSTMENOPAUSAL REPRODUCTIVE HEALTH effects ofmenopause by time of onset Immediate (0-5 years) Vasomotor symptoms(hot flushes, night sweats) Psychological symptoms (labial mood, anxiety, tearfulness) Loss of concentration, poor memory, joint ache and pain Dry and itchy skin Hair changes decrease sexual desire Intermediate(3-10years) Vaginal dryness, soreness Dysparunia, urinary urgency Recurrent UTI Long term(>10 years) Osteoporosis, CVS dirorders, dementia
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  CNS Symptoms Vasomotor • Mostlyduring perimenopausal Period • Hot flushes, night sweat(loss of modulating effect of estrogen on serotinergic receptors within thermoregulatory Centre in brain exagerrated peripheral vasodialtory response to minor atmospheric changes) • Sleep disturbance poor performance and quality of life.
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  Psychological symptoms • Tiredness •Anxiety and depression Cognitive function • Memory changes THE GENITAL TRACT Changes in menstrual bleeding Endometrial effects Initially scanty bleeding because of low estrogenic endometrial stimulation and then completely stop.
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  Urogenital and vulvovaginalatrophy • Vaginal dryness, burning, irritation, Dysparunia, shrinkage and fusion of labia and narrowing of vaginal introitus. • Loss of oestrogenic support Vaginal epithelium less elastic, more easily traumatized • Incontinence , prolapse, urogynaecological problems Bone health • Loss of estrogenic support on skeleton osteoporotic fractures • Bone formation(osteoblasts) decreases and bone destruction increases(osteoclasts). Bone density peaks at 20 to 30 then declines afterwards then a steady decline till menopause then accelerated loss until 60 years then further steady decline till death.
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  disorder characterized bycompromised bone strength predisposing to an increased risk of fracture. Male to female ratio 1:4 RISK FACTORS FOR OSTEOPOROSIS 1-Family history 4-long term steroid use 7-Disorders of thyroid and parathyroid metabolism 2-smoking 5-POI and hypogonadism 8-immobility 3-Alcoholism 6-Medical treatment of gynecological conditions with induced menopause 9-disorders of gut absorption, Malnutrition, liver diseses.
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  CVS symptoms • Dueto low estrogen following changes are observed 1. Incresed TAGs, total cholesterol, LDL and reduction in HDL 2. Femlae physiology changes, nutrition, exercise, changes in fat distribution from a more gynaecoid to android . 3. Loss of estrogenic support on vessel walls(^atherogenesis)
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  Management of menopause •Treatment options 1. Non Pharmacological - Lifestyle modification - Natural herbs & remedies - Diet & suppliments, vit C, E 2. Pharmacological - Hormone replacement therapy (HRT) - Alpha 2 agonist - Beta blockers - Gabapentin
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  Hormone replacement therapy(HRT) • Includes a wide range of hormonal products(estrogen, progesterone, androgens, tibolone) with various methods & routes of administration, potentially different risks and benefits • The international menopause society (IMS) HRT
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  Contraindications & potentialside-effects Absolute Relative - Pregnancy/ breastfeeding - h/o of benign breast disease - Endometrial cancer - large uterine fibroids - Current Venous thromboembolism - unexplained vaginal bleeding - Active liver disease - Migraine/ headaches
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  Side effects ofHRT • Oestrogen Progesterone - Breast tenderness - PMS like symptoms - Leg cramps - Breakthrough bleeding - Nausea - Breast tenderness - Depression mood swings
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  Thank you 