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33 Cards in this Set

  • Front
  • Back
Menopause
Permanent cessation of menstruation.
Climacteric
The phase of life which marks the gradual transition from the era of reproduction to that of senility.
Menopause is just a ........
It is not considered to be a disease, but a ......
Menopause is just a manifestation of the climacteric.
It is not considered to be a disease, but a physiological event.
Natural Menopause:
When it sets in at the normal age
(around 50 years old)
Premature Menopause:
Spontaneously appears at a younger age
(Younger than 40 years old)
Artificial Menopause:
When it is artificially induced
(surgical removal, destruction by deep radiation, or medically induced)
Premature Menopause
It is when menstruation stops for .... period under the age of ...., with absence of ....., and with .....
at least 6 months
40 years old
follicles in ovarian biopsy
a high menopausal level of FSH.
Causes of premature menopause
A- Constitutional or familial.
B- Chemical insult by chemotherapy, or by cytotoxic agents.
C- Infections destroying ovarian tissues (e.g. Mumps, or typhoid oophoritis, or bilateral ovarian abcesses)
Delayed Menopause
It is when menstruation continues after the age of ....
Causes .....
Risks
-55 Years old.
-(Constitutional or Familial / Associated with multiple fibroids / Functional Ovarian tumours / In Diabetic women / Obesity).
-(Associated with an increasedd risk of Endometrial carcinoma)
Menopause is caused by (physiology):
Depletion of both ovaries from all the primordial , and graafian follicles, which have undergone atresia, during her reproductive period of life (since menarche).
When does it all start?
Menopause starts between ....

Climacteric starts...... than cessation of menstruation and lasts for .....
-the age of 45 – 50 years.
- 1 - 2 years earlier
-2 - 3 years after it.
The onset menopause may take any of the following ways
Irregular bleeding.
Oligomenorrhea.
Polymenorrhea.
Sudden cessation of menstruation.
Morphological changes of the menopause
1- Local, genital.
2- General.
3- Hormonal.
Local Changes (Genital)
Ovaries shrink in size.
Breast become flabby and redundant.
Pubic hair become gray and scanty.
Labia majora lose their fat pads.
Enteroitus become patulous.
Dry vagina.
Vagina loses its rugae.
Dyspareunia
Portiovaginalis becomes atrophic and shrink in size.
Uterus becomes atrophic and shrink in size.
Ligamentous support become redundant.
Predisposition to genital prolapse.
Urinary problems related to continence.
General Changes.
Gradual disappearance of secodary sexual characters.
Tendencey to alopecia.
Increased facial hair.
Blood pressure increases.
Weakening of the bones (Osteoporosis).
Atherosclerosis with increased tendency for heart diseases.
Hormonal Changes.
Excess FSH excretion in urine.
Excessive androgen production by the suprarenal glands.
Increased thyroid function due to high TSH by the active pituitary gland.
mechanism
Depletion of follicles from both ovaries
No estradiol secretion from the follicles
Release of the anterior pituitary gonadotrophs from the inhibition of estradiol.
Increased level of FSH and LH.
Anterior pituitary gland works excessively
Increased ACTH production
Increased androgen production by the suprarenal gland.
Hirsutism
Symptoms of menopause
Vasomotor Symptoms
Nervous Symptoms:
Metabolic Symptoms:
Gastrointestinal Symptoms
Genitourinary Symptoms
Vasomotor Symptoms:
Hot flushes.
Palpitations.
Cold sweats.
Constipation.
Headcahes.
Dizziness.
Nervous Symptoms:
Insomnia.
Tinnitus.
Psychological changes.
Anxiety
Mood changes.
Depression.
Metabolic Symptoms:
Obesity.
Arthritic and bone pains.
Diabetes .
Hypertension
Gastrointestinal Symptoms:
Flatulence and constipation and altered appetite
Genitourinary Symptoms:
Dryness.
Dyspareunia.
Recurent urinary tract infections.
Urinary incontinence.
Treatment of Menopause
1- Reassurance.
2- General measures.
3- Hormonal Replacement Therapy
1- Reassurance:
Good comprehensive talk.
2- General treatment:
Diet control.
Life style changes (Exercises)
Sedatives and tranquilizers.
Non hormonal management of vasomotor smptoms (Clonidine / Beta blockes / Tibolone)
3- Hormonal treatment:
Estrogens.
Estrogen plus Progesterone.
Androgens, or progestogens alone or combined.
Calcitonin for osteoporosis.
Hormone Replacement Therapy (HRT)
Mostly Estrogen alone or in combination with Progesterone.
Improves quality of life of the patient.
Has many advantages.
Has many disadvanges.
Can be administered in several forms.
Advantages of HRT.
Prevention of vasomotor symptoms (Hot flushes)
Prevent or reverse the genital changes.
Prevent Osteoporosis.
Prevent the genitourinary complaints.
Prevent the emotional and psychological complaints.
Prevent the hypertension and heart diseases.
Increases life expectancy.
Disadvantages of HRT
Withdrowal bleeding (regular or irregular)
Endometrial hyperplasia and risk of endometrial carcinoma.
Increased risk Cancer breast.
Other effects (nausea / salt and water retension /weight gain / headaches)
Forms of administration of HRT
Oral pills.
Dermal patches.
Injections
Duration of use:
Should be used for life unless intolerance occurs, or patient suffers from side effects.
Follow up during HRT
Annual Uterine U/S for the endometrial thickness (Should be less than 4 mm thick).
Annual Pap smear for cancer cervix.
Annual Breast U/S and Mammography.