Menopause

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1. 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.

2. 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 .

3. 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

4. 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. 

5. 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.

6. 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.

7. 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

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

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

10. VASOMOTOR SYMPTOMS Hot flashes Night sweats Sleep disturbance

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

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

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

14. 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

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

16. 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

17. Phytoestrogens to reduce hot flashes Soy protein to reduce hot flashes Vit E to reduce hot flashes

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

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

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

21. 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

22. 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

23. 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

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