Menopause and Its Effects on Women's Health
Overview of menopause covering its definition, physiological and non-physiological aspects, effects on women, treatment options, and hormonal replacement therapy. Learn about perimenopause, postmenopause, causes of premature ovarian insufficiency, and the effects of menopause on vascular, genital, and bone health.
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University of Basrah Al-Zahraa Medical College Ministry of higher Education and Scientific Research Academic year 2021-2022 5th year REPRODUCTIVE BLOCK Lecture 4 Duration : 1 hour MENOPAUSE Presented by Dr.RAYA MUSLIM AL HASSAN Block staff: Dr.Raya Muslim Al Hassan (BLOCK leader) Dr.Marwa Sadik (co leader) Dr. Abdul kareem Hussain Subber Dr.Alaa Hufdhi GYNAECOLOGY 20th EDITION by Ten Teachers
University of Basrah Al-Zahraa Medical College Ministry of higher Education and Scientific Research LEARNING OBJECTIVES Know the definition of menopause. Understand physiological and non-physiological menopause. Understand the effect of menopause on women. Explain the main forms of treatment of the menopause. Know the side-effects and the contraindications of hormonal replacement
University of Basrah Al-Zahraa Medical College Ministry of higher Education and Scientific Research Menopause: the last menstrual period (LMP). Perimenopause: time of life from the onset of ovarian dysfunction until 1 year after the last period and the diagnosis of menopause is made. This time is also known as the climacteric. Postmenopause: all women who have been 1 year since their last period are deemed postmenopausal.
University of Basrah Al-Zahraa Medical College Ministry of higher Education and Scientific Research PHYSIOLOGICAL AND NON PHYSIOLOGICAL MENOPAUSE Oestrogen levels fall dramatically * Less ve feedback, so LH and FSH levels rise * FSH rises dramatically due to loss of Inhibin too
University of Basrah Al-Zahraa Medical College Ministry of higher Education and Scientific Research Principal causes of premature ovarian insufficiency 1- Primary: Chromosome anomalies (e.g. Turner s, fragile X) Autoimmune disease (e.g. hypothyroidism, Addison s, myasthenia gravis) Enzyme deficiencies (e.g. galactosaemia, 17a-hydroxylase deficiency) 2- Secondary: Chemotherapy or radiotherapy Infections (e.g. tuberculosis, mumps, malaria, varicella)
University of Basrah Al-Zahraa Medical College Ministry of higher Education and Scientific Research Effects of menopause Vascular Genital Bone 1. Vascular Hot flushes affect ~80% to some degree Transient rises in skin temperature and flushes
University of Basrah Al-Zahraa Medical College Ministry of higher Education and Scientific Research 2.genital 2.genital Uterus Regression of endometrium Shrinkage of myometrium Shrinks away into a very small organ cervix thinning of cervix Vagina rugae lost Thinner, less distensible Breast Involution of some breast tissue Changes in skin Bladder Reduction in bladder tone
University of Basrah Al-Zahraa Medical College Ministry of higher Education and Scientific Research 3. Bone effects 3. Bone effects Bone mass reduces by 2.5% per year for several 2.5% per year for several years years Increased resorption relative to production leading to Osteoporosis * Much greater in some than others * Major reason for fractures in later life * Can be limited by Oestrogen Oestrogen therapy
University of Basrah Al-Zahraa Medical College Ministry of higher Education and Scientific Research Benefit of HRT Symptoms improved: vasomotor symptoms; sleep patterns performance during the day. Prevention of osteoporosis: increased bone mineral density; reduced incidence of fragility fractures. Lower genital tract: dryness; soreness; dyspareunia; CVD: preventative effect if started early in menopause.
University of Basrah Al-Zahraa Medical College Ministry of higher Education and Scientific Research Side-effects associated with oestrogen:- breast tenderness or swelling; nausea; leg cramps; headaches. Side-effects associated with progestogen: fluid retention; breast tenderness; headaches; mood swings; depression; acne.
University of Basrah Al-Zahraa Medical College Ministry of higher Education and Scientific Research Most side-effects can be managed with a change in the dose of oestrogen or a change in the type of progestogen. Some patients can also benefit from a switch of route. Many women find the IUS a useful device as it delivers much less progestogen into the circulation, thus reducing progestogenic side- effects.
University of Basrah Al-Zahraa Medical College Ministry of higher Education and Scientific Research Absolute contraindications: suspected pregnancy; breast cancer; endometrial cancer; active liver disease; uncontrolled hypertension; known current venous thromboembolism (VTE); known thrombophilia (e.g. Factor V leiden)
