ANATOMICAL AND PHYSIOLOGICAL FEATURES OF MENOPAUSE IN WOMEN Done by: Akbota K. 340GM Checked by: JSC Astana Medical University

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

PHASES OF MENOPAUSE Pre-menopause : The broad definition of pre- menopause is the time prior to menopause.The occurrence of menopause before the age of 40 years Peri menopause : A period of womens life characterized by the physiological changes associated with the end of reproduction capacity and terminating with the completion of menopause also called climacteric Menopausal phase : It is the end of menstruation. The age of menopause ranges between 45 – 55 years, average being 50 years Post-menopausal : It is defined formally as the time after which a women has experienced 12 consecutive month of amenorrhea without period

INCIDENCE Physiologic menopause : The normal decline in ovarian function due to ageing begins in most women between ages 45 and 55 on average 51 and result in infrequent ovulation, decreased menstrual function and eventually cessation of menstruation. Pathologic menopause : The gradual or abrupt cessation of menstruation before 40 years occur idiopathically

PHYSIOLOGICAL CHANGES Increased cholesterol level in the blood: Hyperlipidemia in the blood is common. This lead to gradual rise in the risk of heart disease and stroke after menopause. Osteoporosis : Calcium loss from the bone is increased in the first five years after the onset of menopause, resulting in a loss of bone density

Digestive system : Motor activity of the entire digestive tract is diminished after menopause. The intestine tend to be sluggish resulting in constipation. Urinary system: As the estrogen level decreases after menopause, the tissue lining the urethra and the bladder become drier, thinner and less elastic. This can lead to increased frequency of passing urine as well as an increased tendency to develop UTI.

Changes in genital organs Uterus : The uterus become small and fibrotic due to atrophy of the muscles after the menopause. The cervix become smaller and appears to flush with vagina. In older women the cervix may be impossible to identify separately from vagina. The vaginal and cervical discharge decreases in amount and later disappear completely. Ovaries : The ovaries become smaller and shriveled in appearance. The ovaries which produce little androgen during reproductive life begin to produce it in increasing amounts. Vagina : The vaginal mucous membrane becomes thin and loses its rugosity after the menopause. Decreased secretion make vagina dry. Sexual intercourse become painful and difficult due to pain from the dry vagina. Vulva or external genital organs : The fat in the labia majora and the Mons pubis decreases and pubic hair become spare. Breast : In thin built women the breast become flat and shriveled while in heavy built women they remain flabby and pendulous.

Hot flashes : Hot flashes are incidents where the women in menopause gets a sudden feeling of warmth and flushing that starts in the face and quickly spread all over the neck and upper body. This `hot flashes can occur at any time of the day or night. Night sweat: Night sweat are closely related to hot flashes. Both usually occur simultaneously. Sweat can occur any time of the day or night, they are more common at night. The sweat can be severe enough to wake up the women from a sound sleep and may make it difficult for her to go back to sleep. CHANGES IN THE VASOMOTOR SYSTEM

TREATMENT Non-hormonal treatment(symptomatic) Hormone Replacement Therapy HRT can be administered orally( in pill form),vaginally( as a cream),or transdermally ( in patch form)

TYPES OF HRT 1. Estrogen and progesterone :The most common type of HRT involves both estrogen and progesterone. During this therapy, estrogen is given regularly while progesterone is added in on a supplementary basis These two hormones are given in combination in order to prevent the overgrowth of uterine lining. Estrogen alone may irritate this lining which could lead to endometrial cancer. 2. Estrogen only : Estrogen therapy alone is usually given to women who have lost their uterus due to surgical menopause. Because no uterus is present, the need for progesterone is not as great.

3. Progestin only: Progestin-only therapy is not prescribed very often. Progestin does seem to provide excellent relief for women plagued with hot flashes.

RISKS OF HRT 1. Endometrial cancer: when estrogen is given alone to a women with intact uterus, causes endometrial proliferation, hyperplasia and carcinoma. 2. Breast cancer: combined estrogen and progestin replacement therapy, increases the risk of breast cancer slightly. 3. Venous thromboembolic disease (VTE): It has been found to be increased with the use of combined oral estrogen and progestin. 4. Lipid metabolism: An increased incidence of gallbladder disease has been observed following ERT due to rise in cholesterol (in bile). 5. Dementia, Alzheimer disease are increased.

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BIBLIOGRAPHY Medicine climacterium / Ed. V.P. Sour point. - Yaroslavl: Literature, p. Henderson V.W. 4 European congress on menopause / Eds. M. Birkhauser, H. Rosembaum. - Vienna: ESKA, P Practical recommendations for hormone replacement therapy in peri and postmenopause. Recommendations from an Expert Workshop Feb 2004 // Climacteric Vol 7. - P The prescriber's guide to Hormone Replacement Therapy / Ed. by M. Whitehead. - N.Y.: The Parthenon Publishing Group, p. Writing Group for the Women's Health Initiative Risks and Benefits of Estrogen plus Progestin in Healthy Postmenopausal Women.Principal results from the Women's Health Initiative Randomized Controlled Trial // JAMA Vol P