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- 1. Mrs. A walked into the menopausal clinic looking distraught.
She was a 50 year old housewife, mother of two children who had
spent her entire lifetime looking after the family. Her
menstruation had stopped 1 year ago and she was miserable,
depressed and irritable, had several hot flushes throughout the day
and night and could hardly sleep for 3-4 hours. Her husband was a
busy executive and travelled a lot; her children had grown up and
left home. She was lonely and left unwanted
- 2. Sanchari Dutta Priyadharshini. M PRIYADHARSHINI.M
- 3. Menopause Greek: menos:month, pausis:cessation Permanent
cessation of menstruation resulting from loss of ovarian follicular
activity(WHO) It also refers to states of ovarian failure &
ovarian destruction/removal with accompanying estrogen deficiency.
(Amenorrhea for 1 year) Marks the end of reproductive life
RETROSPECTIVE DIAGNOSIS(1 year from FMP)
- 4. FSH Ovary Hypothalmus Inhibin B + GnRH Normal Ovary
Reproductive Aging Hormonal Changes
- 5. FSH Ovary Hypothalmus Estradiol / Inhibin B + GnRH
Menopausal Ovary Reproductive Aging Hormonal Changes
- 6. Stages of Reproductive Aging Workshop (STRAW)- WHO
STRAW
- 7. Perimenopause/Climacteric (greek : klimax-ladder) Follows
period of declining fertility Precedes menopause Characterized by
cycle irregularity (shortening then lengthening) increasing
symptoms Duration 2 to 8 years (average 5 years)
- 8. Diagnosing Perimenopause Clinical diagnosis based on
menstrual cycle pattern. Early follicular phase FSH and symptoms
may help solidify diagnosis. Rule out hypothyroidism, depression
etc.
- 9. Perimenopause -- Symptoms Vasomotor instability (85%) Sleep
disturbances Mood disturbances. Somatic symptoms: Fatigue,
palpitations, headache, increased migraine, breast pain and
enlargement. Oligo- Anovulation heavier or irregular cycles. Highly
Variable
- 10. Managing Perimenopause Goals: Patient education Prevention
of endometrial cancer Individualized symptomatic relief Menstrual
control Minimizing hot flashes Mood disturbances
- 11. Menopause Facts Average age -51 years (1% - 40, 5%- >
55) Factors impacting age at menopause Maternal age at menopause
Tobacco, SES/ Education, Alcohol, BMI Factors that probably dont
impact on age at menopause- OCP use, Parity, Race, Height 70% -
symptoms may occur before menopause is biochemically or clinically
evident spontaneously improve over 2-5 years
- 12. Premature Menopause- aged below 40 years. Early Menopause
-aged 50 - 59 years. Late Menopause aged 60 years or over Surgical
menopause- surgical removal of both ovaries in a woman. Medical
menopause- permanent damage to both ovaries in a woman following
either chemotherapy or radiotherapy.
- 13. What is Menopausal transition? Progressive endocrinologic
continuum that takes reproductive aged women from regular, cyclic,
predictable mestruation that are characteristics of ovulatory
cycles, to a final menstrual period(FMP) associated with ovarian
senescence and menopause
- 14. Signs and Symptoms During the Menopausal Transition Adapted
from Bungay G et al. Br Med J 1980;281:1813; Van Keep PA et al.
Maturitas 1990;12:16370. Vasomotor Symptoms Sleep Disorders Mood
Changes Urogenital Atrophy Dyspareunia Osteoporosis Atherosclerosis
Coronary Heart Disease Cerebrovascular Disease 40 yrs 50 yrs
Menopause 60 yrs Menstrual Disorders
- 15. DIAGNOSIS OF MENOPAUSE a. Clinical Criteria 1. age around
menopause ( around 50 years ) 2. no periods for 12 months 3.
menopausal symptoms However, where in doubt, laboratory testing of
FSH may support the diagnosis b. Laboratory Criterion 1. FSH level
> 35miu/ml 2. Estrogen 5 years) VASOMOTOR CASCADE Hot Flashes
Sleep Disruption Daytime Fatigue & Irritability
- 18. Managing Hot Flushes/Flashes Set realistic goals! Lower the
ambient temperature Estrogen (80-95% reduction) Alternative
therapies High dose progestin Tibolone SSRIs (Paroxetine,
Fluoxetine(+/-)) SNRI (Venlafaxine (+/-)) Gabapentin Clonidine
(+/-)
- 19. Effect of ERT and HRT on Number of Hot Flushes Over 12
Weeks Efficacy-evaluable population included women who recorded
taking study medication and had at least 7 moderate-to-severe
flushes/day or at least 50 flushes per week at baseline. *Adjusted
for baseline. Mean hot flushes at baseline = 12.3 (range,
11.313.8). Adapted from Utian WH, et al. Fertil Steril.
2001;75:1065-79. 0 2 4 6 8 10 12 1 2 3 4 5 6 7 8 9 10 11 12 Week
AdjustedDailyMean Number* 0.625 CEE Placebo 0.625 CEE/2.5 MPA
- 20. Sleep and Mood Disturbances Sleep disturbances history of
depression-at risk of reoccurrence Cognition: Lack of agreement-
menopausal impact on cognition Vascular infarcts associated with
estrogen may worsen dementia in women over 65
- 21. Metabolic Changes with Menopause Mechanisms of
Menopause-Related Increases in Adiposity Hormonal changes of the
menopause transition Preferential abdominal fat accumulation
Increased fat accumulation Increased abdominal and intra-abdominal
adiposity Altered energy metabolism
- 22. The Menopausal Metabolic Syndrome Lipid Triad
Hypertriglyceridemia LDL Cholesterol Abnormalities in Insulin
Insulin resistance insulin elimination Other Factors Endothelial
dysfunction visceral fat uric acid HDL Cholesterol insulin
secretion Hyperinsulinemia SHBG blood pressure PAI-1
- 23. Annual Incidence of Myocardial Infarction in Women and Men
in the U.S. 0 100 200 300 400 500 29-44 45-64 >65 Age, years Men
Women No. X 103 Cardiovascular Disease
- 24. Decreased bone mass microarchitectural deterioration of
bone tissue enhanced bone fragility fractures 0.8 0.9 1.0 1.1 50 55
60 65 70 BMD(g/cm2) Perimenopausal Menopausal for 4 Years
Menopausal for 5-14 Years Menopausal for 15 Years Mean Age (years)
n = 1426. Pouills JM, et al. J Bone Miner Res. 1994;9:311-5. Spinal
BMD by Age and Menopausal Status Osteoporosis
- 25. When to Measure BMD in Postmenopausal Women Age > 65
Caucasian race Family history History of fracture History of falls
Bad eyesight Dementia Early menopause (