🔸
menopause
The term menopause is derived from Greek Meno (months) and pause (cessation).
🔸
The word means cessation of menstruation.
The menopause is the permanent cessation of menstruation due to failure ovarian
🔸
function
🔸
The average age of menopause is 51.
Natural menopause is a retrospective diagnosis and defined as 12 months of
amenorrhea without another pathologic cause
🔸
Climacteric
which is by dictionary definition is period of life when fertility and sexual activity decline.
🔸It isPremenopause:
3-5 years period before menopause with increase frequent
It is a wide term leading to: irregular anovulatory bleeding followed by episodes of amenorrhea
-*Pre Menopause 🔸
and intermittent menopausal symptoms.
Post menopause:
-*Peri Menopause
🔸
It is the period of life after menopause
Premature menopause:
🔸
-*Post Menopause
Is menopause before the age of 40 years, occurs in approximately 1%
The phase in the aging process of women marking the transition from the reproductive stage of
of life to the non-reproductive stagefrom 45-55 years.
🔸The number of primordial follicle decline even before birth but dramatic
pathophysiology
🔸
just before menopause.
🔸 Increase FSH, LH from about 10 years before menopause.
Close to menopause:
There will be
-anovulation
-inadequate Leuteal phase → decrease progesterone but not estrogen
level → lead to DUB and endometrial Hyperplasia
🔸 At menopause dramatic decrease of estrogen→menstruation ceases
🔸
and symptoms of menopause started.
But still ovarian stroma produce →small androstenedione and
testosterone but, main postmenopausal estrogen is estrone produced by
🔸
Peripheral fat from adrenal androgen.
The age of menopause appears to be genetically determined and is
unaffected by race, socioeconomic status, age at menarche, or number of
🔸
prior ovulations
Smoking, chemotherapy, radiotherapy , surgery on ovaries and
hysterectomy despite retention of ovaries may cause early menopause
genitourinary atrophy
-Vaginal epithelium becomes thin and palewith loss of rugae
-The PH increase
Symptoms of Menopause: -This will leads to atrophic vaginitis, dysparunia and purities (libido
Menopause and 1.Vasomotor instability: unchanged)
1. Hot flushes cutaneous vasodilatation *vaginitis due to thinning of epithelium, ↓ PH and lubrication.
Climacteric - occurs in 75% of women *dyspariunia→due to decrease vascularity and dryness
- more severe after surgical menopause -decrease size of cervix and mucus with retract of squamocolumnar
- continue for 1 year (SC) junction into the endocervical canal.
by fatema okoff
🔸
- 25% continue more than 5 years -The uterus and ovaries reduced in size, shrinking of
myoma&adenomyosis.
It is a sensation of intense warmth in upper body and spread to face and neck,
-Decrease size of ovaries, become non palpable.
sometimes associated with palpitation and profuse sweating lasting a few seconds to - Laxity of supporting tissues leads to pelvic organ prolapsed
🔸
minutes - Lining of urethra and bladder trigone attenuatedleading to symptoms
The mechanism is unknown but may be due to hypothalamic thermoregulatory center of dysuria, UTI, and urge, frequency , nocturia and incontinence
-Decrease size of breast and benign cysts
🔸
alteration due to decline estrogen
🔸
Hot flushes may precedes menopause by months to years
skin ,hair and nail changes:
It is common at night causing sleep disturbance -Estrogen influences skin thickness.
2.Menstrual Changes -With declining estrogen production, skin tends to become thin, less
Most women note a gradual tapering in both amount and duration of flow elastic, and eventually more susceptible to abrasion and trauma.
Estrogen replacement helps restore the thickness and elasticity of skin.
A minority of women have more frequent and heavier bleeding Estrogen therapy also helps to slow the formation of wrinkles.
Abrupt cessation of menses is fairly rare
somatic and non specific symptoms
3.Collagen Fatigue ,Headache, Anxiety, irritability, nervousness,
It has a positive effect on collagen, which is important for bone and skin. The rate is 2% per Depression, Sleep disturbance, Mood swings, Inability to
year for the first 10 years after menopause. This statistic is similar to that of bone loss and concentrate
strongly suggests a link between skin thickness, bone loss, and osteoporosis. The Psychological changes due to decreased level of central
Reductions in collagen lead to: neurotransmitter
Genitourinary atrophy
Skin changes in
late effect of menopause
Osteoporosis:
- bone mass reach peak at the end of their 3rd decade of life.
- After 40years bone resorption exceeds bone formation by 0.5% per year.
- This negative balance increase after menopause to a loss of 5% of bone per
year.
diagnosis and investigation
medication: The Triad of:
- ERT(Estrogen Replacement Therapy) Hot flushes
-b. Biphosphonate (Fosamax) that inhibit osteoclastic activity & minimal S/E Amenorrhea
-c. Raloxifene (Evista) is selective oestrogen receptors Increase FSH > 15 i.u./L
-moderator [SERMs] that bind with a high affinity to estrogen receptors. It Before starting treatment: You should perform
has some oestrogen like effect e.g. ↑ bone density, ↓LDL Cholesterol Breast self examination
Mammogram
[cardioprotective] but act as estrogen antagonist on endometrium and Pelvic exam (Pap Smear)
breast. Weight, Blood pressure
-d. Calcitonin inhibit osteoclastic activity
-e. Calcium Supplement &Vit D.
-Increase calcium intake 1000mg /day 🔸
treatment
Estrogen – a minimum of 2mg of oestradiol is
needed to maintain bone mass and relief symptoms of
-Vitamin D supplementation 400-800IU/day
cardiovascular system :
🔸
menopause.
Women with uterus – add progestin at last 10 days
-CVD is now the leading cause of death among post menopausal women 🔸
to prevent endometrial Hyperplastic
Sequential Regimens- used in patient close to
-before menopause, risk of heart attack is 1/3 of man
-after menopause increase in women become the same of man at an age of 🔸
menopause.
Oestrogen – in the first ½ of 28 day per pack
70years
- Because of effect of estrogen: 🔸
&Oestrogen&Progetin in 2nd 1/12 of 28 day pack.
Combined continuous therapy who has
Progesterone everyday – is useful for women who are
*Before menopause: increase HDL & decrease LDL.
*decrease Atherogenic plague formation by direct action on vascular few years past the menopause and who do not to have
endothelium
* After menopause:HDL : LDL ratio become closer to male ratio 🔸
vaginal bleeding.
There is evidence that increase risk of endometrial
cancer with sequential regimens for > 5 years while on
combined continuous regimens decrease risk of Cancer.
urogenital system :
The Urethra and vagina have a high concentration of estrogen receptors and there
is significant evidence to support one use of estrogen in treatment of urogenital
symptoms such as (recurrent UTI, vaginitis and dysparunia)
menopause
The term menopause is derived from Greek Meno (months) and pause (cessation).
🔸
The word means cessation of menstruation.
The menopause is the permanent cessation of menstruation due to failure ovarian
🔸
function
🔸
The average age of menopause is 51.
Natural menopause is a retrospective diagnosis and defined as 12 months of
amenorrhea without another pathologic cause
🔸
Climacteric
which is by dictionary definition is period of life when fertility and sexual activity decline.
🔸It isPremenopause:
3-5 years period before menopause with increase frequent
It is a wide term leading to: irregular anovulatory bleeding followed by episodes of amenorrhea
-*Pre Menopause 🔸
and intermittent menopausal symptoms.
Post menopause:
-*Peri Menopause
🔸
It is the period of life after menopause
Premature menopause:
🔸
-*Post Menopause
Is menopause before the age of 40 years, occurs in approximately 1%
The phase in the aging process of women marking the transition from the reproductive stage of
of life to the non-reproductive stagefrom 45-55 years.
🔸The number of primordial follicle decline even before birth but dramatic
pathophysiology
🔸
just before menopause.
🔸 Increase FSH, LH from about 10 years before menopause.
Close to menopause:
There will be
-anovulation
-inadequate Leuteal phase → decrease progesterone but not estrogen
level → lead to DUB and endometrial Hyperplasia
🔸 At menopause dramatic decrease of estrogen→menstruation ceases
🔸
and symptoms of menopause started.
But still ovarian stroma produce →small androstenedione and
testosterone but, main postmenopausal estrogen is estrone produced by
🔸
Peripheral fat from adrenal androgen.
The age of menopause appears to be genetically determined and is
unaffected by race, socioeconomic status, age at menarche, or number of
🔸
prior ovulations
Smoking, chemotherapy, radiotherapy , surgery on ovaries and
hysterectomy despite retention of ovaries may cause early menopause
genitourinary atrophy
-Vaginal epithelium becomes thin and palewith loss of rugae
-The PH increase
Symptoms of Menopause: -This will leads to atrophic vaginitis, dysparunia and purities (libido
Menopause and 1.Vasomotor instability: unchanged)
1. Hot flushes cutaneous vasodilatation *vaginitis due to thinning of epithelium, ↓ PH and lubrication.
Climacteric - occurs in 75% of women *dyspariunia→due to decrease vascularity and dryness
- more severe after surgical menopause -decrease size of cervix and mucus with retract of squamocolumnar
- continue for 1 year (SC) junction into the endocervical canal.
by fatema okoff
🔸
- 25% continue more than 5 years -The uterus and ovaries reduced in size, shrinking of
myoma&adenomyosis.
It is a sensation of intense warmth in upper body and spread to face and neck,
-Decrease size of ovaries, become non palpable.
sometimes associated with palpitation and profuse sweating lasting a few seconds to - Laxity of supporting tissues leads to pelvic organ prolapsed
🔸
minutes - Lining of urethra and bladder trigone attenuatedleading to symptoms
The mechanism is unknown but may be due to hypothalamic thermoregulatory center of dysuria, UTI, and urge, frequency , nocturia and incontinence
-Decrease size of breast and benign cysts
🔸
alteration due to decline estrogen
🔸
Hot flushes may precedes menopause by months to years
skin ,hair and nail changes:
It is common at night causing sleep disturbance -Estrogen influences skin thickness.
2.Menstrual Changes -With declining estrogen production, skin tends to become thin, less
Most women note a gradual tapering in both amount and duration of flow elastic, and eventually more susceptible to abrasion and trauma.
Estrogen replacement helps restore the thickness and elasticity of skin.
A minority of women have more frequent and heavier bleeding Estrogen therapy also helps to slow the formation of wrinkles.
Abrupt cessation of menses is fairly rare
somatic and non specific symptoms
3.Collagen Fatigue ,Headache, Anxiety, irritability, nervousness,
It has a positive effect on collagen, which is important for bone and skin. The rate is 2% per Depression, Sleep disturbance, Mood swings, Inability to
year for the first 10 years after menopause. This statistic is similar to that of bone loss and concentrate
strongly suggests a link between skin thickness, bone loss, and osteoporosis. The Psychological changes due to decreased level of central
Reductions in collagen lead to: neurotransmitter
Genitourinary atrophy
Skin changes in
late effect of menopause
Osteoporosis:
- bone mass reach peak at the end of their 3rd decade of life.
- After 40years bone resorption exceeds bone formation by 0.5% per year.
- This negative balance increase after menopause to a loss of 5% of bone per
year.
diagnosis and investigation
medication: The Triad of:
- ERT(Estrogen Replacement Therapy) Hot flushes
-b. Biphosphonate (Fosamax) that inhibit osteoclastic activity & minimal S/E Amenorrhea
-c. Raloxifene (Evista) is selective oestrogen receptors Increase FSH > 15 i.u./L
-moderator [SERMs] that bind with a high affinity to estrogen receptors. It Before starting treatment: You should perform
has some oestrogen like effect e.g. ↑ bone density, ↓LDL Cholesterol Breast self examination
Mammogram
[cardioprotective] but act as estrogen antagonist on endometrium and Pelvic exam (Pap Smear)
breast. Weight, Blood pressure
-d. Calcitonin inhibit osteoclastic activity
-e. Calcium Supplement &Vit D.
-Increase calcium intake 1000mg /day 🔸
treatment
Estrogen – a minimum of 2mg of oestradiol is
needed to maintain bone mass and relief symptoms of
-Vitamin D supplementation 400-800IU/day
cardiovascular system :
🔸
menopause.
Women with uterus – add progestin at last 10 days
-CVD is now the leading cause of death among post menopausal women 🔸
to prevent endometrial Hyperplastic
Sequential Regimens- used in patient close to
-before menopause, risk of heart attack is 1/3 of man
-after menopause increase in women become the same of man at an age of 🔸
menopause.
Oestrogen – in the first ½ of 28 day per pack
70years
- Because of effect of estrogen: 🔸
&Oestrogen&Progetin in 2nd 1/12 of 28 day pack.
Combined continuous therapy who has
Progesterone everyday – is useful for women who are
*Before menopause: increase HDL & decrease LDL.
*decrease Atherogenic plague formation by direct action on vascular few years past the menopause and who do not to have
endothelium
* After menopause:HDL : LDL ratio become closer to male ratio 🔸
vaginal bleeding.
There is evidence that increase risk of endometrial
cancer with sequential regimens for > 5 years while on
combined continuous regimens decrease risk of Cancer.
urogenital system :
The Urethra and vagina have a high concentration of estrogen receptors and there
is significant evidence to support one use of estrogen in treatment of urogenital
symptoms such as (recurrent UTI, vaginitis and dysparunia)
