Menopause
Menopause is defined as final or permanent cessation of menstruation. Age of menopause varies from 45-55 years and averages is about 47 years.
Phases of menopause
The phases of menopause is usually occur in 4 categories.
Pre-menopause
If menopause occurs before 35 years it is called premature menopause.
Peri- menopause
A period of women’s life characterized by the physiological changes associated with the end of reproduction capacity & terminating with the completion of menopause also called climacteric.
Symptoms of peri-menopausal mood swings
- Sudden bouts of sadness
- An inability to concentrate
- Lack of motivation
- Irrational anger
- Increased fatigue
Types of irregular periods during peri- menopause
- Shorter periods
- Longer periods
- Extremely light periods
- Extremely heavy periods
- Skipped or missed periods
Menopausal phase
- It is the end of menstruation. The age of menopause ranges between 45-55 years, averages being 50 years.
Post-menopausal
- It is defined formally as the time after which a women has experienced 12 conservatives month of amenorrhea without period.
Sign & Symptoms
- Postmenopausal sleep disorders are mostly caused by disturbed hormone levels.
- Women may still experience night sweats during post menopause.
Causes of menopause
It occurs when the ovaries are totally depleted of eggs and no amount if stimulation from the regulating hormones can force them to work.
Mechanism
During menopause, cessation of menstruation occura in one of the following 3 ways.
1. Progressively scanty blood loss followed by cessation of menstruation.
2. There is prolonged interval between menstrual period and finally menstruation steps.
3. Sudden cessation of menstruation.
Climactrics
It is a period at which the women gradually changes from the reproductive to non- reproductive type. It is a physiological process and occurs mainly due to stop of cessation of ovarian follicular function.
Physiological changes during menopause
The lack of estrogen & progesterone cause many changes in women’s physiology that affected their health and well being. The symptoms of menopause due to changes in the metabolism of the body.
1. Increased cholesterol level in the blood
Hyperlipidemia or an increase in the level of cholesterol & lipids in the blood is common. This lead to gradual rise in the risk of heart disease & stroke after menopause.
2. Osteoporosis
Calcium loss from the bone is increased in the first five years after the onset of menopause, resulting in a loss of bone density. The calcium moves out of the bones, leaving them weak & liable to fracture at the smallest stress.
3. Digestive system
After menopause motor activity of the entire digestive tract is diminished . The intestine tend to be sluggish resulting may be in constipation.
4. Urinary system
As the estrogen level decrease after menopause, the tissues lining the urethra & the bladder become drier, thinner & less elastic. Because of this it increased frequency of passing urine as well as an increased tendency to develop UTI.
5. Changes in gential organs
- Ovaries become small and there is complete exhaustion of follicles.
- Uterus becomes small and fibrotic due to atrophy of muscle after the menopause. The cervix become smaller & apper to flush with vagina. In older women cervix may be difficult to identify separately from the vagina. The vaginal and cervical discharges decreases in amount and later disappear completely.
- Endometrium become thick and atrophied.
- Vagina contacts with shallowness of formices. The vaginal mucous membranes becomes thin & losses its rugosity after the menopause. Decreased secretion make vagina dry. Sexual intercourse become painful & difficult due to pain from the dry vagina.
- Vulva or external gential organs: The fat in the labia majora and the mons pubis decreases and pubic hair become spare.
Breast
In thin built women the breast become flat and shriveled while in heavy women they remain flabby and pendulous.
Changes in the general appearance
Skin: The skin loses its elasticity & become thin and fine. This is due to the loss of elastin & collagen from the skin.
Weight: Weight increases is more likely to be the result of irregular food habit due to mood swing. There will a more deposition of fats around the hip, waist & buttocks.
Hair: Hair become dry & coarse after menopause. Due to the decreasing level of estrogen, there may be hair loss.
Voice : Due to thickening of vocal cords, voice get deeper.
Test and Diagnosis
History collection
- Usually menopause is considered complete after 1 year of amenorrhea.
- Types typically aren’t needed to diagnose menopause.
- But under certain circumstances, doctors may recommend blood tests to check your level of
Follicles-stimulating hormone (FSH) and estrogen
- Menopause occurs because your FSH levels increase & estradiol levels decrease.
Thryoid stimulating hormones (TSH)
- Because an underactive thyroid can cause symptoms similar to those of menopause.
Medical management
Non- hormonal treatment
- There are a variety of menopausal treatments both natural and medical that can be alleviate the symptoms of menopause.
- Dressing in light layers can alleviate hot flashes & night sweat, avoiding caffeine, alcohol & spicy foods can also minimize these symptoms.
- Menopause & weight gain tend to go toghter due to life style changes than to the hormonal changes. Reducing dietary fat intake & regular exercise help to combat weigt gain during menopause.
- Menopause can lead to osteoporosis, calcium, magnesium and vitamin D can help to restore bone density, which naturally deteriorates after age 30 due to reduced estrogens level.
- Menopause decreases vaginal elasticity, leading to vaginal dryness. Vitamin E can help as can kegal exercises which help restores elasticity.
- Menopause often can lead to dry, itchy skin, & weak thin hair that breaks & that has lots of split ends. Flax seed oil can help restore hair and skin’s healthy appearance as can vitamin E.
Treatment and drugs
To treat menopause requires no medical treatment instead of , treatment focus on relieving your signs & symptoms & preventing or managing chronic conditions that may occurs with aging.
Treatment may include
Hormone therapy – Estrogen therapy remains, by far, the most effective treatment option for relieving menopausal hot flashes. Depending on your personal and family medical history, tour doctors needed to provide symptoms relief for you. Estrogen also helps prevent bone loss. Hormone therapy may also benefit to the heart if started within 5 years after your last menstrual period.
Indications
- Relief of menopausal symptoms
- Relief of vasomotor symptoms
- Prevention of osteoporosis
- To maintain the quality of life.
Contraindication
- Known history of breast cancer.
- Undiagnosed genital tract bleeding
- Estrogen depending neoplasm
- DVT
- Active liver disease
- Jaundice
- Gall bladder disease
- Prior endometriosis
Risk of hormonal therapy
- Endometrial cancer
- Breast cancer
- Venous thromboembolic disease
- CHD
- Lipid metabolism
- Dementia has no benefits
Vaginal estrogens
To relieve the vaginal dryness, estrogen can be directly administered to the vagina by using a vaginal cream, tablet or ring. This treatment can releases a small amount of estrogen, which is absorbed by the vaginal tissues. It can help relieve vagina dryness, discomfort with intercourse and some urinary symptoms.
How to apply vaginal cream
1. Take the cap off the tube of medicine and screw on the applicator.
2. Squeeze the medicine into the applicator slowly until the plunger reaches the prescribed dose measurement. Remove the applicator from the tube of medicine. Keep the cap return back on the tube.
3. Lie on your back with your knee bent. Hold the applicator in one hand.
4. Put the applicator into your vagina as far as you can.
5. Slowly press the plunger until it stops. Remove the applicator. Rinse the applicator.
Low – dose antidepressants
Certain antidepressants related to the class of drugs called selective serotonin reuptake inhibitors may decrease menopausal hot flashes. A low- dose antidepressants for management of hot flashes may be useful for women who can’t take estrogen for health reasons or for women who need an antidepressant for a mood disorder.
Medications to prevent or treat osteoporosis
Depending on the individual needs, doctors may also recommend the medication to prevent or treat the osteoporosis. Several medications are available that help reduce bone loss and risk of fractures.
Before deciding any treatment by own, Consult with your doctor. Review your options yearly, as your needs and treatment options may change.
Ŕisks of surgical menopause
- Cardiovascular disease
- Height loss
- Gum tissues are affected.
Complications
Heart & blood vessels (Cardiovascular ) disease.
- When your estrogen levels decline, your risks of cardiovascular disease increase.
Osteoporosis
This condition causes bone to become brittle and weak, leading to an increased risk of fractures.
Urinary incontinence
As the tissues of your vagina and urethra lose electricity, you may experience frequent, sudden, strong urges to urinate, followed by an involuntary loss of urine.
Sexual function
Loss of elasticity or vaginal dryness from decreased moisture production can cause discomfort.
Weight gain
Many women gain weights during the menopausal transition and after menopause because metabolisms slows.
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