Peri menopausal period syndrome

1. Peri -menopausal Period Syndrome (Climacteric Syndrome ) www.freelivedoctor.com

2. Definition Menopause the cessation of menses for a year or more. It is caused by ovarian failure. It marks the end of a women’s reproductive life It occurs normally between the ages of 45– 55 years and at a mean age of 51 years. It is a physiological process Peri -menopause is a period immediately before and after the menopause. www.freelivedoctor.com

3. Premature ovarian failure ----- the cessation of menses before the age of 40 years. Artificial menopause ------ the cessation of menses is secondary to some causes, such as oophorectomy , radiation therapy. www.freelivedoctor.com

4. Peri -menopausal Period Syndrome peri-menopause accompanied by the symptoms of climacteric, including hot flashes, excessive perspiration, night sweets, depression, agitation, vaginal dryness, insomnia The basic causes of the climacteric syndrome are a progressive decline in ovarian production on estrogens and other sex hormones www.freelivedoctor.com

5. Negative Feedback Secretion of estrogens decreased (ovary) ↓ FSH increased (40-45 years old) ↓ FSH,LH increased(45-50 years old) ↓ FSH increased 14 times LH increased 3 times(menopause ) ↓ FSH, LH gradually decline (3 years after menopause) www.freelivedoctor.com

6. Symptoms and signs 1. Early Symptoms and signs   1) menstraution disorder Oligomenorrhea --- intervals greater than 35 days. Polymenorrhea ---- intervals less than 21 days hypermenorrhea amenorrhea menopause www.freelivedoctor.com

7. 2) vasomotor symptoms ( hot flashes, sweats) oestrogen depletion result in instability in the vessels of the skin. The hot flashes begins on the chest and spreads quickly over the neck, face and upper limbs which lasts only seconds but may recur many times one day. Sweat often follows hot flashes. www.freelivedoctor.com

8. 3) mood changes and sleep disturbances insomnia, headache, backache, depression, hate, having difficulty falling asleep and waking up soon after going to sleep 4)urinary tract problem atrophic change in the urethrovesical epithelium decreased elastic tone of the uterine and urethrovesical supporting structures www.freelivedoctor.com

9. 5) vaginal dryness and genital tract atrophy atropic vaginitis, dyspareunia the vaginal skin become thin and loses its rugose appearance small red spots appear on the vagina www.freelivedoctor.com

10. 2. Late symptoms and problems 6)osteoporosis Accelerated bone loss in women is clearly related to the loss of ovarian function. Studies show that a rapid decrease in bone mass occures within 2 months of ovariotomy www.freelivedoctor.com

11. After natural cessation of ovarian function, bone loss 3% yearly for the first 6 years By age 65, half of women have bone density decreased by 2 standard deviations below the perimenopausal mean. Beyond age 45, the incidence of wrist fractures is 12 times higher in women than in men of same age www.freelivedoctor.com

12. There is now general agreement that postmenopausal osteoporosis is related to estrogen deficiency Estrogen reduce bone resorption more than they reduce bone formation Other factors lack of exercise Malabsorption of calcium www.freelivedoctor.com

13. 7) cardiovascular lipid changes atherosclerosis( 动脉硬化 ) HDL ,LDL, total cholesterol , perimenopaual women have a lower incidence of coronary heart disease than men of same age. This observation led to the supposition that estrogen might be a key factor. But recent data suggest that Estrogen has no such protection against heart disease www.freelivedoctor.com

14. Diagnosis 1) History menstrual abnormality 2) Symptoms: vasomotor symptoms, vaginal dryness, urinary frequency, insomnia, irritability, anxiety, skin change, breast changes, urinary tract problem, pelvic floor change( cystocele . Rectocele . Prolapse ), skeletal change(backache, ) and so on. www.freelivedoctor.com

15. 3)Physical examination: The clinical findings vary greatly depending on the time elapsed since menopause and the severity of the estrogen deficiency Skin: thin ,dry Breast loss turgor The labia are small The uterus becomes much smaller The muscles of the pelvic floor are looser in tone and are thin Prolapse may be present www.freelivedoctor.com

16. 4) Laboratory diagnosis Cytologic smear from the vaginal wall E2, FSH, LH determination Radiography, X-ray densitometry www.freelivedoctor.com

17. Treatment 1)   education, understanding, reassurance 2)   hormone replacement therapy(HRT) Estrogen therapy The use of estrogens can relieve the menopausal symptoms. The hot flashes , sweats and other complaints disappear or improve within a few days of starting estrogens therapy . www.freelivedoctor.com

18. The administration of estrogen without progestogen increases the risk of endometrial cancer and breast cancer. So, correct cyclical therapy, with 10 days progestogen per month , can reduces the incidence of cancer. www.freelivedoctor.com

19. Contraindication thrombo-embolish hypertension diabetes chronic liver disease myomo , endometriosis, breast disease gallbladder disease www.freelivedoctor.com