Menopause
Defination Of Menopause : Permanent of cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity cycle is called menopause.
We will describe :
Common cause of delayed menopause:
What are the clinical features of menopause?
post- menopausal and complication?
Management of menopausal syndrome
What are the common cause of delayed menopause?
Common cause of delayed menopause:
- Constitutional
- Fibroid uterus
- Diabetes mellitus.
- Oestrogenic tumor of the ovary.
What are the clinical features of menopause?
Clinical Features:
A. Vasomotor symptoms:
- Hot Flushes.
- Night sweats.
- Insomnia
- Weakness.
B. Uro- genital symptoms:
- Urinary incontinence
- Dysuria
- Recurrent urinary tract infection.
- Dyspareunia
- Vaginal dryness
- Genital prolapse
C. Neuro- endocrine symptoms:
- Dizziness
- Headache
- Insomnia
- Irritability
D. Skeletal disease:
- Osteoporosis.
- Bone pain
- Fracture of bones.
E. Cardiovascular disease:
- Coronary heart disease.
- Ischemic heart disease.
F. Skin Changes:
- Decreased in elasticity.
- Skin becomes dry as a result, decreasing sweats and sebaceous glands.
- Decrease melanophore activity
- Decrease thermal insulting capacity.
How will you manage a women with menopausal syndrome?
Management of menopausal syndrome :
History :
- Assessment of mental build up of the patient.
- Her social and economical status.
- Sexual life.
- Any gynecological problem.
- Obstetrics history.
- Family history.
- Smoking history
- Dietary habit
Diagnosis :
- Cessation of menstruation for consecutive 12 months during climacteric.
- Appearance of menopausal symptoms hot flush and night sweats.
- Serum oestradiol; <20pg/ml
Treatment :
A. Non hormonal treatment :
- Nutritious diet.
- Supplementary calcium.
- Exercise
- Vitamin-D supplementation
- Cessation of smoking and alcohol
- Bisphosphonates prevents osteoclastic bone resorption
- Fluoride prevents osteoporosis.
- Calcitonin inhibits bone resorption
- Clonidine reduce urinary calcium excretion
- Paroxetine is effective to reduce hot flushes
- Gabapentine.
- Phytoestrigens.
- Soy protein
B. Hormonal Replacement therapy :
- Oestrogen.
- Combined oestrogen and progesterone preparation
- Mixed oestrogen and androgenic preparation.
How will you prevent post- menopausal and complication?
Prevent of post – menopausal symptoms and complication:
- Spontaneous menopause is unavoidable. However, artificial menopause induced by surgery (bilateral-oophorectomy) or by radiation (gonadal) during reproductive period can to some extant be preventable or delayed.
- Counseling: Every woman with posmenopausal symptoms should be adequately explained about the physiologic events. This will remove the fears, and minimize or dispel the symptoms of anxiety, depression and insomnia.
- Reassurance is essential.
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