Menopause

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Menopause
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Menopause

• The terms climacteric and menopause are often
  used inter-changeably actually they have
  different meanings.
• The climacteric is the period of waning ovarian
  function which signal the end of the reproductive
  life span.
• Menopause is the stoppage of menses.
• Menopause is a normal stage of life experienced
  by women all over the world. It occurs typically
  between the ages of 40 and 50 years womens when
  the ovaries stop producing the hormones estrogen
  and progesterone, which are responsible for the
  monthly menstrual cycles. When the ovaries stop
  making these hormones, the menstrual cycles stop
  as well.

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The climacteric

• The climacteric is characterized by endocrinal,
  somatic and transitory psychological changes.
• The climacteric may be classified into three
  phases
• Pr-menopausal phase The period of beginning
  physiological failure of ovarian function and it
  lasts for a period ranging from two to six years.
• Menopausal phase.
• Post menopausal phase The remainder of life
  after menopause.
• The age of menopauses ranges from 40 to 50 years

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Types of menopause
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• Physiological menopause
• It is spontaneous progressive decline of ovarian
  function that starts at the age of 40 to 50
  years.
• Pathological menopause
• Premature menopause It is premature ovarian
  failure before age of 40.years and affect 1 of
  all women under the age of 40.
• Artificial menopause It is permanent cessation
  of ovarian function caused by surgical removal of
  the ovaries or by irradiation using either intra
  uterine radium or deep x-ray with about 600 rads.
• Delayed menopause It is a cessation of
  menstruation above the age of 50.

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Menopausal changes

• ?in circulating estrogen and progesrton, ?
  production of gonadotrophin. (changes differ from
  woman to another)
• Breast changes
• ? subcutaneous fat, but later due to ?in
  circulating estrogen, subcutaneous fat resorbed,
  atrophy of the gland tissue, the breast flattened
  and pendulous.
• 2) Female genital organs
• Ovaries ? size, non
  functional and unable to respond to
• 
  circulating gonadotrophins.
• Uterus and tubes Become progressively
  atrophic.
• Vagina and vulva Thinning of the mucosa,
  easily irritated
• 
  ?vaginal secretion (? acidity), pathogenic
• 
  organisms can be developed, atrophy of the
• 
  vaginal epithelium.
• Urethra Atrophy of mucosa
  and development of
• 
  urethritis.
• Pelvic floor muscles loss of their tones, loss
  of elasticity of
• connective
  tissue, development of prolapse and stress
• incontinence

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• 3. Cardiovascular system
• Vasomotor disturbance, Hot flushes with feeling
  of heat centered on the face which spreads to the
  neck and chest and may become generalized. Each
  hot flush lasts between 1.5 and 3 minutes,
  associated with peripheral vasodilatation and
  increase of heart rate.
• Symptoms of hot flashes may include some or all
  of the following
• A feeling of extreme warmth
• Sweating that is sudden and may be drenching
• Fatigue
• Irritability
• Headaches
• Joint pain
• Interruptions in sleep or night sweats
• Hot flashes may be followed by a feeling of
  extreme cold and shivering.
• Vaginal dryness, which may lead to pain during
  intercourse, is another symptom of menopause that
  some women experience.

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• 4. Psychological changes irritation, depression
  and insomnia.
• 5. Obesity due to
• ?appetite and alteration of carbohydrate
  metabolism as a result of hyper function of
  anterior lobe of pituitary gland.
• 6. Osteoporosis affects more the vertebrae with
  one or more of the following
• Bone pain back pain (most common) due to
  declines of vertebral mineral content.
• Fractures Thoracic, lumber, hip and colles
  fractures of the wrist.
• Loss of height compression fractures of
  vertebrae, kyphosis.
• Deformities e.g. thoracic kyphosis in two forms,
  
• Round kyphosis when several vertebrae are
  affected (smooth thoracic curveture)
• Angular kyphosis when only one or few
  vertebrae are affected (Dowager hump)

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Management of menopausal changes
Management of menopausal changes
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Management of menopausal changes

• General treatment
• Reassurance (through proper explanation about
  this changes).
• Improve general health.
• Diet control (avoid obesity)
• Hormonal treatment
• Administration of estrogen, estrogen with
  progestrogens hormones.
• Medical treatment sedative drugs and calcium
  intake.
• Preventive treatment
• A program of regular aerobic and resistance
  exercises and training to prevent or minimize
  many problems such as cardiovascular diseases,
  obesity, depression and osteoporosis.

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Exercises and cardiovascular diseases in post
menoupausal women

• Cardiovascular diseases increase in women after
  menopause, regular aerobic exercises to improve
  cardiovascular endurance and reduce the risk of
  cardiovascular diseases.
• The recommended exercises should be 30 minutes at
  a time, three times / week at 60 of maximum
  oxygen consumption (VO2max)

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Exercises and obesity in post menoupausal women

• Obesity is a risk factor for cardiovascular
  diseases and diabetes.
• Aerobic exercises will lead to decrease of
  abdominal fat due to several mechanisms
  including, ?energy expenditure, ?metabolic rate
  and altered body composition.
• The recommended exercises should be 60 minutes /
  day, three times / week at 50 of maximum oxygen
  consumption (VO2max)

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Exercises and bone loss in post menoupausal women

• Regular exercises weight bearing exercises e.g.
  (walking, jogging and climbing stairs) and non
  weight bearing exercises e.g. (bicycle, swimming
  and spine exercises are most conservative and
  least costly measures to provide protection
  against bone loss
• The recommended exercises should be 30 minutes /
  day, three times / week at 60 of maximum oxygen
  consumption (VO2max)

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Exercises and deoression in post menoupausal women

• Exercises raises brain nor-epinephrine
  concentrations and prevents depression,
• Aerobic exercises (walking or jogging) leads to
  high concentration of nor-epinephrine and
  serotonin.

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Biological effect of exercises on the bone

• The possible mechanism of exercises for keeping
  the skeletal integrity are
• Change blood biochemical structure
• skeletal remolding is modulated by calcium,
  phosphours, and calcitrophic hormones
  availability during and after exercises increase
  bone mineral density.
• Intense interval exercise at 60 (VO2max) will
  cause ? the plasma concentration of sex hormone
  estrogen.
• 2) Mechanical load of exercises will cause
  ?bone mass
• Muscle contraction and gravity create piezo
  electric forces which affect bone remolding,
  compression of bone causes negative potential at
  the compressed site and positive potential else
  where, causing osteoblatic activity at the
  negative end of the current flow, causing
  increased deposition of calcium at the
  compression site.

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Methods used for prevention of osteoporosis

• Electromagnetic fields (EMFs)
• Pulsating electromagnetic field (PEMFs)
  with 10 micro volt/cm and frequency between
  50-150 Hz one hour/day are able to slow down the
  loss of bone mass.
• Mechanism of action
• Piezo electric potentials in loaded bone
  affect skeletal mass.
• It causes a maximum potential gradient
  which able of increasing net calcium flux in
  human osteoblast like cells.
• It maintain a constant high osteogenetic
  activity and osteogenesis and reduce the
  resorption on the bone surface.
• 2. Pulsed ultrasonic
• With frequency of 1.5 MHz and intensity
  from o.5 to 2 W/cm for 10 minutes/day had effect
  on the rate of bone regeneration.
• Mechanism of action
• By electromechanical kinetic effect on the
  cell membrane interfaces of the bone.
• 3. Electrical stimulation
• Can be used to stimulate bone regeneration.

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