1. Seminar on menopause

2. introduction
Menopause is the end of menstruation. The word menopause comes from the greek word ‘mens’ meaning ‘monthly’ and ‘pausis’ meaning ‘cessation’. Menopause is the part of a women’s natural ageing process when her ovaries produce lower level of estrogen and progesteron and when she no longer able to become pregnant.

3. definition
Menopause means permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity.

4. Phases of menopause
Menopause transition : Is the period of time during which a women passes from the reproductive to the non-reproductive stage. This phase covers 4-7 years on either side of menopause.

5. Phases of menopause
Perimenopause.
Menopause.
Postmenopause.

6. Age of menopause
Age at which menopause occur is genetically predermined. The age of menopause is not related to age of menarche or age at last pregnancy. It is also not related to number of pregnancy, lactation, use of oral pill, socioeconomic condition, race, height or weight.

7. Cont…..
Thinner women have early menopause. However cigarette smoking and severe malnutrition may cause early menopause. The age of menopause ranges between years, average being 50 years.

8. Organ changes Ovaries Fallopian tube. The uterus. The vagina.
The vulva.

10. Menopausal symptoms
In majority apart from cessation of menstruation no more are evident. In some women, symptoms appear. The important symptoms and health concern of menopause :
Vasomotor symptoms
Genital and urinary system
Osteoporosis and fracture
Vagina
Sexual dysfunction

13. Diagnosis of menopause
Cessation of menstruation cycle for consecutive 12 months during climacteric.
Average age of menopause 50 years.
Appearance of menopausal symptoms ‘ hot flash’ and ‘night sweats’.
Vaginal cytology showing features of low estrogen.
Serum estradiol is less than 20 pg/ml.
Serum FSH and LH is greater than 40 mIu/ml at 1 week interval for three times.

14. management Prevention :
Spontaneous menopause is unavoidable. However, artificial menopause induced by surgery (bilateral oophorectomy) or radiation (gonadal) or chemotherapy during reproductive period can to some extent be preventable or delayed.
Counselling :
Every women with postmenopausal symptoms should be adequately explained about the physiologic events. This will remove her fears and minimize or dispel the symptoms of anxiety, depression and insomnia. Reassurance is essential.

15. treatment Paroxetine Non-hormonal treatment Gabapentin
Lifestyle modification
Nutritional diet
Supplementary calcium
Exercise
Vitamin-D
Cessation of smoking and alcohol
Gabapentin
Phytoestrogens
Soy protein
Vitamin-E
Bisphosphonates
Calcitonin
Clonidine
Paroxetine

18. Hormonal therapy Indication of hormonal therapy :
The hormonal therapy is indicated in menopausal women to overcome the short term and long term consequences of estrogen deficiency.
Indication of hormonal therapy :
Relief from menopausal symptoms.
Relief from vasomotor symptoms.
Prevention of osteoporosis.
To maintain the quality of life in menopausal years.
Special group of women to whom HT should be prescribed :
Premature ovarian failure.
Gonadal dysgenesis.
Surgical or radiation menopause.

19. Benefits of hormonal therapy
Improvement of vasomotor symptoms ( 70-80%)
Improvement of urogenital atrophy.
Increase in bone mineral density ( 2-5% )
Decreased risk in vertebral and hip fracture ( 25-50%)
Reduction in colorectal cancer.
Possibly cardio protection.

21. Contraindication of HT
Known, suspected or history of breast cancer.
Undiagnosed genital tract bleeding.
Estrogen dependent neoplasm in the body.
History of venous thromboembolism or active deep vein thrombosis.
Active liver disease.
Prior cholestatic disease.
Gallbladder disease.
Prior endometriosis.

22. Available preparation

23. Cont…. Oral estrogen regimen – 0.3 mg or 0.625 mg
Estrogen and cyclic progestin- for women with intact uterus, estrogen is given continuously for 25 days and progestin added to day.
Continuous estrogen and progestin therapy – can prevent endometrial hyperplasia.

24. Transdermal administration – risk of thromboembolism or gallbladder disease are not increased compared to oral route
Subdermal implants – implants are inserted subcutaneous over the anterior abdominal wall using local anaesthesia.
Percutaneous estrogen gel – 1 g applicator of gel delivering 1 mg of estradiol daily is to be applied onto the skin over the anterior abdominal wall.

25. Transdermal patch – it contains 3.2 mg of beta estradiol.
It should be applied below the waist line and changed twice a week.
Vaginal cream – conjugated equine vaginal estrogen cream 1.25 mg daily is very effective.
Progestins – in patients with history of breast carcinoma or endometrial carcinoma, progestins may be used.

26. Tibolone – is a steroid having weak estrogenic, progestogenic
Tibolone – is a steroid having weak estrogenic, progestogenic. It prevents osteoporosis.
Parathyroid hormone – recombinant PTH is given by injection to prevent osteoporosis and fracture.
Complementary and alternative medicine – acupuncture decrease hot flush frequency.

27. Duration of hormonal therapy
Generally use of HT for a short period as long as the benefits outweigh the risks. Individual woman need counseling with annual or semiannual review.
Reduction of dosages should be done as soon as possible. Menopausal women should maintain optimum nutrition, ideal body weight and perform regular exercise.

28. Abnormal menopause Delayed menopause Artificial menopause
Premature menopause
Delayed menopause
Artificial menopause
Surgical menopause
Radiation menopause

29. Male menopause/ andropause

30. introduction
Male menopause is the more common term for andropause. It describe age related changes in male hormone levels. The same group of symptoms is also known as testosterone deficiency, androgen deficiency, and last hypogonadism.

31. definition
Male menopause involves a drop in testosterone production in male who are age 50 or older. Its often affiliated with hypogonadism. Both condition involve lowered testosterone levels and similar symptoms.

32. Causes of male menopause
After a man reaches the age of 30 years, testosterone level gradually decrease, falling an average of percent each year.
However, doctors do not believe that the normal, age-related decline of testosterone levels is at the centre of male menopause symptoms. Every man would experience them, which is not a case.

33. Cont….
This condition that changing condition levels of male hormone are not the sole contributor to this condition:
Other risk factors are as follows :
Lack of exercise
Smoking
Alcohol consumption

34. Cont…. Stress Anxiety Sleep deprivation Erectile dysfunction
Any psychological problem
Hypogonadism
Poor diet

35. Symptoms of male menopause
Low energy
Depression or sadness
Decreased motivation
Lowered self confidence
Difficulty in concentration
Insomnia

37. Diagnostic test Physical examination Ask about symptoms
Test to rule out medical problems that may be contributing to the condition.
Order blood test to rule out or helps to measure testosterone level

38. treatment Symptomatic treatment
If person having nutritional problem advice to take well balanced diet.
People with diabetes and cardiovascular disease will require management.
If any psychological problem provide psychotherapy and drugs.

39. Hormonal therapy
A doctor may recommend testosterone therapy if symptoms are not treated.
Testosterone therapy may have so many side effects such as urinary tract blockage, prostate cancer , ischemic heart disease and sleep apnea.

40. Forms of testosterone supplements
Skin patch
Gels
Mouth patch
Injection and implants

41. Risks of testosterone therapy
Side effects are a primary drawbacks of hormonal therapy with testosterone. while some of the side effects are relatively minor, other are more serious:
Minor side effects :
Fluid retention
Sleep apnea
Decreased sperm count
Decreased testicle size

42. Cont…. Acne Breast enlargement Blurry vision Increased urination
Severe side effects
Increased cholesterol level
High blood pressure
Muscles pain
Chest pain

43. conclusion
Menopause is characterized by metabolic, hormonal and clinical changes, low sexual desire often reduces women’s quality of life and causes personal distress. By providing symptomatic treatment we can manage the symptoms and also by providing hormonal therapy that also helps to reduce symptoms. Andropause is also called as male menopause. In this also we are providing symptomatic treatment and hormonal therapy.