Topic of presentation is menopause in women

Menopause

1. TOPIC MENOPAUSE PHYSIOLOGICAL,PSYCHOLOGICAL AND SOCIAL ASPECTS HARMONE REPLACEMENT THERAPY SURGICAL MENOPAUSE COUNSELLING AND GUIDANCE.

2. INTRODUCTION: Menopause is the end of menstruation. The word menopause came from Greek word ‘mens’ means ‘monthly 'and ‘pausis’ meaning ‘cessation’. Part of a women’s natural ageing process.

3. DEFINITION Menopause is the permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity. Age of menopause : 45-55 (average 55). Menopause before 40 years : Early menopause 40-45 years of age: pre-menopause 45-55: normal menopause Above 55: delayed menopause .

4. ENDOCRINOLOGY OF MENOPAUSE Few years prior to menopause , depletion of ovarian follicles occur and existing follicles become resistant against gonadotropins. Results in impaired folliculogenesis and decreased estradiol production The serum estradiol level falls from 50-300pg/ml to 10-20pg/ml. Results in anovulation and corpus letuem insufficiency. Oestrogen and progesterone level decreases. Endometrial growth stops Results in absence of menstruation ( MENOPAUSE).

5. PHYSIOLOGICAL CHANGES: Lack of oestrogen and progesterone cause many changes in women’s physiology. ESTROGEN: Normal level; 50-300pg/ml During menopause: 10-20pg/ml PROGESTERONE; Normal level: 1-6ng/ml Menopause: 1-2ng/ml.

6. 01.INCREASED CHOLESTROL LEVEL: Increase in HDL and decrease in LDL , leading to risk of heart diseases and stroke. 02.OSTEOPOROSIS: 3-5% per year decrease in bone mass , due to decreased oestrogen level. 03.DIGESTIVE SYSTEM : Motor activity diminished , sluggish intestines and constipation. 04.URINARY SYSTEM: Stress incontinence-50ml/day Increased frequency , increased tendency to develop UTI.

7. CHANGES IN GENITAL ORGANS : UTERUS: Small and fibrotic due to atrophy of muscles , prone to uterine prolapse. Cervix becomes smaller. Vaginal and cervical discharge decreases. OVARIES: Size shrinks , produce increased amount of androgen.

8. VAGINA: Elasticity decreases , mucous membrane becomes thin Vagina becomes dry Dyspareunia. VULVA: Decreased fat in labia majora and Mons pubis Spare pubic hair. BREAST: Flat and shrivelled in normal built women Flabby and pendulous in heavy built women.

9. CHANGES IN GENERAL APPEARANCE : SKIN: Looses elasticity Thin and fine WEIGHT: Increases Fat deposition around hips , waist and buttocks. HAIR: Dry and coarse More hair loss.

10. CHANGES IN VASOMOTOR SYSTEM: HOT FLUSHES - Most common symptom. Mainly in face and neck. 1 in every 1 hour Mainly in night hours. Subside with age. NIGHT SWEAT : Related to hot flushes Cause palpitation .

11. PSYCHOLOGICAL CHANGES : Frequent headache ,irritability ,fatigue , depression and insomnia. Diminished interest in sex. SOCIAL CHANGES: Women vary in there subjective experiences of symptoms.

12. HARMONE REPLACEMENT THERAPY (HRT): Indicated in menopausal women to overcome short-term and long-term consequences of oestrogen deficiency. Administered orally ( pills) ,vaginally (cream),transdermally (patches). Used before , during and after menopause.

13. INDICATIONS OF HRT: Relief of menopausal symptoms Prevention of osteoporosis Maintain quality of life The special group of women to whom HRT should be prescribed are: Premature ovarian failure Gonadal dysgenesis Surgical or radiation menopause.

14. TYPES OF HRT: 01.ESTROGEN AND PROGESTERONE: Most common type. More than 8 million women currently taking . Designed for women who have a uterus. Oestrogen given regularly , while progesterone added on supplementary basis. Combination prevents overgrowth of uterine lining. Oestrogen alone may irritate lining causing endometrial cancer.

15. 02.ESTROGEN ONLY : Given to women who have lost their uterus due to surgical menopause. 03.PROGESTIN ONLY: Not prescribed very often.

16. AVAILABLE PREPRATIONS OF HRT: The principle hormone used in HRT is oestrogen. Commonly used oestrogen are conjugated oestrogen (0.625-1.25mg/dl). Progestin used are medroxyprogesterone (100-300mg/dl). Low dose of oral conjugated oestrogen 0.3mg daily is effective with minimal side effects.

17. 01.ORAL ESTROGEN REGIME : Estrogen 0.3mg or 0.625 mg daily for women having hysterectomy. 02.ESTROGEN AND CYCLIC PROGESTIN : For women with uterus , Estrogen given continuously for 25 days and progestin added for last 12-14 days. 03.CONTINOUS ESTROGEN AND PROGESTERONE THERAPY : Prevents endometrial hyperplasia.

18. 04.SUB DERMAL IMPLANTS: Implanted subcutaneously over anterior abdominal wall using LA. 17beta oestradiol implants: 25mg,50mg or 100 mg-kept for 6 months . 05.PERCUTANEOUS ESTROGEN GEL : 1gm applicator of gel delivering 1mg of oestradiol daily applied on skin over anterior abdominal wall or thigh.

19. 06.TRANSDERMAL PATCH: Contains 3.2mg of 17beta oestradiol releasing about 50 microgram of oestradiol in 24 hrs. Kept below waist line , changed twice a week. 07.VAGINAL CREAM: Vaginal Estrogen cream 1.25 mg daily effective for atrophic vaginitis. 08.PROGESTIN: Medroxy progesterone 2.5-5mg/day. 09.TIBOLONE: 2.5mg per day –it is a steroid.

20. DURATION OF HRT: For 3-5 years. RISKS OF HRT: Endometrial cancer Breast cancer Venous thrombolytic disease(VTE) Dementia , Alzheimer’s disease increased.

21. SURGICAL MENOPAUSE: Induced menopause in which both ovaries are surgically removed. Can occur at any age before natural menopause occurs. Abrupt cutoff of ovarian hormones causes sudden hot flushes , dry vagina and decline in sex drive. Hormone therapy used to treat symptoms.

22. COUNSELLING AND GUIDANCE: Important to understand the individual’s needs and priorities when providing counselling: KEY POINTS: Decision making process Problems reported by women Emotional support.

23. CONCLUSION: Menopause is a natural process , brought about by age , it could also occur as a result of certain iatrogenic factors. The average age is 45-55 years. Symptoms may worsen except vulvovaginal atrophy Hormone therapy is mainstay in management of menopause.

24. RECAPITULATION: 01Menopause occurring in the age of 40-45 is termed as……………. 02 The serum estradiol level in menopause falls to a range of…………. 03 Normal level of Estrogen is…………. 04Most common symptom of menopause is……. 05Oral Estrogen regime consists of …………..mg of daily Estrogen. 06Duration of HRT is………….

25. ANSWER KEY pre-menopause 10-20pg/ml 50-300pg/ml Hot flushes 0.3mg daily 3-5years

26. ROLE OF MIDWIFERY NURSE PRACTIONER IN MENOPAUSE.