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2. What is it?-and why do we care?And WHY there is so much controversy? 3. Menopause Cessation of Menstruation. Its derived from a Greek words Menos and PauseMeaning Cessation of Menstruation. Definition: Permanent stoppage of Menstruation as aresult of declining ovarian function leading to deficient ovarian hormonal secretions. 4. FSH & LH Estrogen and Progesterone 5. Fertile Years:Fairly Predictable Teen years:Perimenopause:+/- RoughVariable Menopause:Menses PauseAge 0 10203040 50 60708090 100Menarche: The Beginning SPC SURAT 9825356080/31-07-11 6. Ideal monthly cycles:smooth hormonal balanced d d d d d d d d d d d 7. Menopause strictly means the end (pause) of menses. Menopause is a hypo-estrogenic state. Estrogen surges have caused growth of theendometrium. Now no growth = no shedding = no period ~ FSH over 40 Average age 51-52. 8. By definition means the time around menopause.(Could mean anytime from birth to death. ) Usually refers to the transitional years leadingfrom regular menses to the end of menses and thesymptomatic years. Ages 35 to 60. Low, unreliable Progesterone & FluctuatingEstrogen. 9. Age related depletion of ovarian follicles Degeneration of Granulosa & Theca cells Degenerating Theca cells fail to respond to Gn Leads to fall in estrogen levels Decrease in negative feedback on HPA axis Consequent rise in Gn attempting to stimulate ovaries Sharman et al 1976 10. These process begins 5 year before actual menopause At this time FHS and Estradiol LH and Progesterone levels remain unchanged,indicating that cycle probably continue to be ovulatory. Estradiol Hot flushes 11. In contrast to follicular cells, the stromal cells continue toproduce androgens in response to LH after Menopause, The adrenals continue to produce androgens The physiologic in Estrogen / Androgen ratio accountsfor increase in facial hair growth after menopause. In obese women androgens are converted by peripheral bodyfat to a weak estrogen estrone Hence they are less prone to menopausal symptoms andosteoporosis but increase chance of endometrial hyperplasiaand malignancy. 12. 30 to 50 years of your life. Uncomfortable Symptoms. Possibly disruptive Possible increase PMS (mood changes,sadness, lack of concentration). More abnormal bleeding iron deficiency. Decline in general health. Huge impact on reproductive system. 13. 200 years ago, fewer than 30% of women livedlong enough to experience menopause. 100 years ago the average womens life expectancyjust reached 50 years of age. NOW-Average life expectancy is 80 and most ofyou will far surpass that. Ready or not, you can already expect a betterQUANTITY of life. So the question really becomes - How can Imaintain the best QUALITY of life? 14. They welcome Menopause freedom from bleeding and risk ofpregnancy Feel free to participate in religious and social activities. Psychological symptoms are fewer joint family strong support Lifestyle of rural India more physical activities fiber rich diet, lowfat, good intake of milk and exposure to sun shine Hot flushes are common in the white Caucasian women thenIndian. Urogenital symptoms common in Indians. Decreased libido shy to discuss 15. Survey of knowledge attitude and symptomatology menopause and HRT in qualified nurses revealed substantial degree of paucity of knowledge amongst them. 66.6% - only were familiar in premenopausal group 48.5% - in menopausal group KEM hospital Mumbai (Kansaria et al 2000) 16. Survey (on the basis of questionnaire) of knowledge attitudeand symptomatology of menopause, HRT and Cancer inqualified 352 educated working class women. 40% of them had read about menopause in newspapers. 48% considered it as media hype, and the despite of the factthat 26% of them being postmenopausal, only 2.9% were onHRT. This survey emphasizes the need for enhancing publicawareness of menopause and its implications.Monali Desai 2003, Vadodara 17. Menopausal impacts can be divided into two categories - short term and long termEstrogen Withdrawal Symptoms-short term (Resolve with time)hot flashesnight sweats sleeplessness fatigue mental lapses moodiness irritability palpitations headaches many othersMOST DISAPPEAR WITH TIME. 18. Estrogen Deficiency -- ( Worsen with time) Vaginal effects (dryness, atrophy) Genitalia (atrophy) Brain (cognitive decline) Loss of libido Bone (loss of mineral density) Joints (tightness) Blood vessels (atherosclerosis) Metabolic ( insulin Skin (wrinkling) resistance) Mucus membranes (dryness) Macular degeneration OthersTHESE IMPACTS DO NOT FADE - THEY GET WORSE. 19. Questions to resolve: A. Could anything be done?--- YES B. What would be the options? C. How safe are they? 20. 1) NATURAL - Live a Healthy Lifestyle Enhance and accept what nature has given you.2) ALTERNATIVE use supplements, vitamins, naturopathic and homeopathic remedies.3) MEDICAL TREATMENTS treat specific symptoms or problems with medications as they arise.4) HORMONAL replace the original substance that is missing - prevention. (Similar to treatment of low thyroid) 21. 1. Detail personal and family history, physical examination including height, weight and BP2. Breast examination, pelvic examination & PAPs test3. Evaluation of symptoms and need for medication4. Evaluation of individual risk Vs benefits from treatment5. Routine screening test: CBC, Urine analysis, blood sugars, RFT, LFT6. Lipid profile and CVS risk assessment 22. 7. TVS and Assessment of Endometrial thickness8. Routine mammography9. Assessment of BMD DEXA (Dual Energy X-ray Absorptiometry) test is preferable10. Endometrial biopsy in postmenopausal bleeding or F/H/O cancer or P/H/O late menopause, infertility and PCOD.11. Stool test for occult blood [for colorectal disease]12. TSH, and free T3, T413. FHS, LH in women on OC pills with secondary amenorrhea or in hysterectomised patients. 23. Medical treatments begin after a problem develops. Traditionally, this is what most of us choose. We seem to assume that disease is inevitable.Eventually we all will get something. This refers to specific drug therapies to treatconditions or disease states as they arise, or evenbefore that. 24. Improves vasomotor stability, reducing hot flashes. Helps maintain elasticity of skin and tissues. Improves sleep patterns, decreases fatigue. Increased sense of well being. Better recall, memory, problem solving. 25. Cardiovascular Risk Insomnia Osteoporosis Ovarian cancer Colon cancer Diabetes Endometrial cancer Breast cancer Dementia Clotting Deep Vein Thrombosis & Stroke Macular degeneration Arthritis 26. Timing of treatment - Its important to start early toget the full benefit. Many of the benefits persist if you continue therapyfor longer periods of time. Mode of delivery Various routes NON-ORAL Have advantages over oral. 27. Lets assume for the moment that there are safe choices. Therapy depends on your particular situation. Where you are in this transition process. Depends on your goals, health conditions, budget, etc. 28. NO symptoms. Its great not to have symptoms , still you face the decline in health associated with the loss of estrogen. This is a group of Patients thats harder to convince! Pt. doesnt have symptoms so she doesnt feel bad. They wont feel the slow loss of calcium in bones until its too late. Consider HRT to prevent some of the long term effects of chronic estrogen deficiency. 29. Lifestyle changes and Personal habits Exercises: Brisk walking for 40 60 min., at least 5 times /week Physical workout: Wt. bearing exercises for limbs and backstrengthening. Yoga and Meditation: Breathing exercises stress Simple Diet: Plenty of vegetables, fruits fat, Sugar Fluid Intake: Plenty of fluids to maintain hydration. Control or Abstain: smoking, alcohol intake, more tea andcoffee. 30. Womens bodies are genetically programmed to gothrough a fertile phase that ends with the onset ofmenopause. Natural phenomenon - why not accept it gracefully,and work to improve life quality by diet, exercise, andnatural supplements.Much to be said for this lifestyle.Symptoms - not everyone has them, or they may bemild, and even if uncomfortable, will usually resolve