MENOPAUSE

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MENOPAUSE

• A natural, normal physiological change.
• Permanent cessation of menstruation.
• Not a disease or a medical problem.
• From reproductive life to non-reproductive life.
• Complex mix of areas
• physical
• social
• psychological
• cultural
• spiritual

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MENOPAUSE

• Long transition period leading to menopause
• climacteric, a.k.a. perimenopause
• Age
• 35-60
• Climacteric
• ovaries less and less responsive to FSH
• decline of estrogen and progesterone production

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MENOPAUSE

• Climacteric (Contd)
• ovulation skips anovulatory cycles
• periods less blood, shorter, skips, irregular
• less testosterone
• Still capable of reproduction
• Menopause
• 12 continuous months without a period

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MENOPAUSE

• Some estrogen and progesterone produced by
• adrenal glands
• skin
• muscle
• brain
• pineal gland
• hair follicles
• These hormones stored in fatty tissue

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MENOPAUSE

• Universal signs of menopause
• cessation of menses
• cessation of ovulation
• decreased hormonal output
• vaginal dryness
• skin changes

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MENOPAUSE

• Non-universal changes
• hot flashes
• tachycardia
• headaches
• memory lapses
• fatigue
• irritability
• depression
• Cultural differences

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MENOPAUSE

• Associated medical conditions
• Osteoporosis (brittle bones)
• Heart Disease
• Osteoporosis
• Bones lack calcium, become weak, easily broken.
  North American diet relatively high in calcium.
  No correlation between amount of Ca in diet and
  incidence of osteoporosis (Asia).

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MENOPAUSE

• Osteoporosis (Contd)
• But excess of protein in the diet results in
  Ca loss during metabolism.
• Prevention
• exercise (aerobic and weights)
• good diet, phytoestrogens
• no smoking

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MENOPAUSE

• Osteoporosis (Contd)
• Men also get osteoporosis after about age 50 yet
  they do not suffer estrogen deprivation.
• Women 1 in 4, men 1 in 8
• Muscle mass helps to prevent osteoporosis. Men
  usually have more muscle due to testosterone.
• Baseline bone density test, repeat 5 years

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MENOPAUSE

• Heart Disease
• Uncommon until 20th century
• Longevity
• womens life expectancy from 48 to 84.
• Genetics and Lifestyle

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MENOPAUSE

• Heart Disease (Contd)
• Factors that increase incidence
• excess weight
• consumption of bad fats
• sedentary life
• smoking (first and second hand)
• contraceptive pill
• These are cumulative greater effects with
  increased age.
• Same preventative measures as for osteoporosis.
  Baseline for blood pressure and stress test.

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MENOPAUSE

• Hormone Replacement Therapy (HRT)
• Completely discredited today. HRT can cause
• reproductive cancers
• heart disease
• dementias
• asthma
• hearing loss
• memory loss
• and other health problems

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MENOPAUSE

• Exercise
• as essential as breathing and eating
• Benefits
• healthy weight
• energy
• mental acuity
• antidepressant
• strengthens immune system, lower incidence of all
  morbidity
• stress buster

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MENOPAUSE

• Exercise (Contd)
• Benefits
• improves sex life
• sweating important for cleaning toxins, skin
• cardiovascular health lower incidence of heart
  attacks and strokes
• lower incidence of osteoporosis
• low incidence of menopausal symptoms
• helps with balance in old age

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MENOPAUSE

• Exercise (Contd)
• Should be a life-long habit. Lifestyle
  coadjuvants
• no smoking
• balanced diet
• good sleep habits

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MENOPAUSE

• Exercise (Contd)
• Barriers
• urbanization
• TV
• computers
• desk jobs
• multiple demands on women, double shift
• affluence, mechanization (cars, shopping, etc.)
• pharmaceutical culture
• no tangible cultural rewards
• not a serious part of school curriculum
• not part of traditional female role

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MENOPAUSE

• Psycho-Socio-Cultural Aspects of Menopause
• In Western cultures menopause is associated with
  decline and with loss of status for women.
• Aging seen as loss of value.

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MENOPAUSE

• Fear of Aging Associated With Menopause Causes
• negative expectations
• negative thoughts and emotions
• defeatist behaviours
• So menopausal symptoms are magnified.

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MENOPAUSE

• Cultural Influences
• Sex for procreation only
• Sex is for the young
• Old people who have sex are dirty and disgusting

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MENOPAUSE

• Culture and Menopause
• Androcentric Image of Women
• sexy
• young
• fertile
• Post-Menopausal women
• dry
• withered
• unattractive
• Advertising
• Medicine

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MENOPAUSE

• Importance of youth reinforced by
• cosmetic industry
• fashion industry
• cosmetic surgery fad
• medical-pharmaceutical industry
• Western illness model is very profitable.

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MENOPAUSE

• Some Cultures Associate Menopause with
• power
• wisdom
• high social status
• leadership roles
• respect
• In these cultures women have few complaints about
  menopause

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MENOPAUSE

• Menopause and Sex
• 50 report more enjoyment
• no fear of pregnancy
• partners slower
• more self-assured
• Use of artificial lubricants
• Vagina
• use it or lose it (atrophy)

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ANDROPAUSE

• Male Climacteric (Male Menopause or Andropause)
• 40-55
• Some real physical changes less obvious than
  women
• Confounded with normal aging changes
• less energy
• slower RT (reaction time)
• less vigorous responses

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ANDROPAUSE

• And With Disease effects
• diabetes
• circulatory
• depression
• surgery
• medications
• hypercholesterolemia
• kidney problems
• prostate problems

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ANDROPAUSE

• Testosterone Drops
• testosterone maintains muscle, stimulates bone
  health, so less testosterone leads to reduced
  muscle mass and weaker bones.
• Sperm Count
• also affected (drops) due to testosterone drop.

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ANDROPAUSE

• Sexual Performance Declines
• increased episodes of impotence
• genitals shrink, prostate enlarges
• more time to reach arousal
• erections less hard
• ejaculations less forceful, less quantity
• increased refractory period

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ANDROPAUSE

• Estrogen Drops
• estrogen helps cardiac health, prevents
  atherosclerosis, counteracts LDL cholesterol, so
  less estrogen increases probability of
  atherosclerosis (arterial plaque) and of bad
  cholesterol.
• More and more men on HRT.
• Sildenafil (Viagra)
• Cialis
• Levitra

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ANDROPAUSE

• HRT for Men
• Testosterone
• Can cause
• prostate cancer
• prostate enlargement
• blood clots
• lower HDL (the good cholesterol)
• heart disease
• Same prevention
• lifestyle