Menopause

DEFINITION:

• Menopause is the permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity
• The symptoms of menopause are best treated with estrogen

INCIDENCE:

• Physiologic menopause: The normal decline in ovarian function due to ageing begins in most women between ages 45 and 55 on average 51 and result in infrequent ovulation, decreased menstrual function and eventually cessation of menstruation.
• Pathologic menopause : The gradual or abrupt cessation of menstruation before 40 years occur idiopathically in about 5% of women in USA.
• The incidence of carcinoma of the breast is increased in woman who Have an early menarche and late menopause

PHASES OF MENOPAUSE

The phases of menopause is usually broken down into four categories:-

• Pre-menopause: The broad definition of pre-menopause is the time prior to menopause .Peri menopause: A period of women’s life characterized by the physiological changes associated with the end of reproduction capacity and terminating with the completion of menopause also called climacteric
• The occurrence of menopause before the age of 40 years.
• Menopausal phase : It is the end of menstruation . The age of menopause ranges between 45 – 55 years , average being 50 years.
• Post-menopausal : It is defined formally as the time after which a women has experienced 12 consecutive month of amenorrhea without period.

CAUSES OF MENOPAUSE

• Menopause occurs when the ovaries are totally depleted of eggs and no amount of stimulation from the regulating hormones can force them to work.

PHYSIOLOGICAL CHANGES

• The lack of estrogen and progesterone causes many changes in women’s physiology that affect their health and well-being . 
• The symptoms of menopause due to changes in the metabolism of the body.
• Increased cholesterol level in the blood: Osteoporosis 
• Hyperlipidemia or an increase in the level of cholesterol and lipids in the blood is common. 
• This lead to gradual rise in the risk of heart disease and stroke after menopause.
• Digestive system :constipation
• Urinary system:↓ estrogen level makes tissue lining the urethra and the bladder drier, thinner and less elastic . This can lead to increased frequency of passing urine as well as an increased tendency to develop UTI.
• Hair become dry and coarse after menopause
• There is a decrease in skin elasticity
• ENDOCRINE:↑ Cholestrol, ↑ Androgen,  ↑ FSH, ↑LH, ↓ estrogen,↑  Gonadotrophins 
• GENITAL ORGANS
• uterus become small and fibrotic
• vaginal and cervical discharge decreases 
• ovaries become smaller and shriveled in appearance 
•  The vaginal mucous membrane becomes thin and loses its rugosity after the menopause
• Decreased secretion make vagina dry
• The fat in the labia majora and the Mons pubis decreases and pubic hair become spare
• Voice become deeper due to thickening of vocal cords.
• VASOMOTOR SYSTEM:Hot flashes , profuse sweating.
• Night sweat
• Carcinoma vulva may be Seen after menopause 
• PSYCHOLOGICAL CHANGES :frequent headache, irritability, fatigue, depression and insomnia