Understanding and managing menopause

Lesson 1: Physiological changes in menopausal and post-menopausal age


Progressive atrophy of genital organs occurs with more individual whose fibrous tissue in them is disposed of.


They go small (5 g. Elk), fibrotic with furrowed surface follicles get exhausted. Ovarian vessels are sclerosed. Cortical stromal hyperplasia is a common finding as a result of high LH levels in women 40¬46 years. Ovarian stroma a source of a few androgens. Fallopian tubes shrink with reduced mortality.

Uterus is small and fibrotic due to atrophy of the muscles. Endometrium becomes thin and atrophic (senile). In some women, endometrium hyperplasia has the chances of taking place after menopause due to constant stimulation estrone. Cervical secretion is scarce, thick and later 4isappears. The vaginal epithelium atrophy with loss of roughness. Vaginal smear demonstrates atrophic changes. Vagina contracts with the shallowness of the fornices. Vulva gradually shrivels with narrowing of the introitus: pelvic cellular tissue gradually lax.

Secondary sex characteristics

Breasts show progressive atrophy decay of the glandular tissue bringing about flabbiness. They have suspended due to the accumulation of fat around. Public and armpit hair is scarce.


Body weight decreases after 65 years. There decrease cell mass of bodies Wrinkles, less elastic appearing with her on the face. Subcutaneous fat storage. Carried on the hips and thighs. Postraenopausally height decreases after 65 years. Can develop kyphosis due to spinal osteoporosis.


Osteoporosis occurs due to estrogen deprivation. Reduction of trabecular bone (collagen matrix) (osteoblasts) and calcium leads to estrogen deprived Osteoporosis. The premenopausal woman is protected from ischaemic heart disease as a result of high HDL and low LDL cholesterol. The latter increases post menopause said the ischaernic incidence of heart disease is also rising. Premature menopause naturally or ovariectomy suffering from an increased risk of cardiovascular disease and osteoporosis.


Hypochlorhydria develops and the Motor activity of the entire digestive tract reduces resulting in constipation and dyspepsia in women after menopause. Bladder and urethral epithelium atrophy.


Emotional disturbances are common. During menopause can increase sex drive. After 60 years of age, sex urges decreases as an aging process.


There is the gonadal failure during menopause. Plasma estradiol declines, estrone remains normal ovarian stroma produces androstenedione. Extra glandular conversion of androstenedione to estrone comes in adipose tissue. Postmenopausally, adrenal cortex is derived from androstenedione the source of estrone. Estrone is the predominant estrogen after menopause. Postmenopausal daily estrone formation was estimated 15,100 ug / day (Mac Donald et al, 1973) and serum content at 30 70 pg / ml. Progesterone separation ceases due to the failure from the ovary of the ovulation. Total urinary estrogen level drops to about 6 PG1 24 hours at the postmenopausal period. Androstenedione level for the most part from the adrenal cortex,   little. From ovary comes to the half that seen for the menopause. Testosterone Mirror does not drop appreciably because postmenopausal ovary secretes more testosterone.

Pituitary gonadotropins. FHS and LH are discharged in more by the nonappearance of negative feedback control of the ovarian steroids. Adulatory LH peak disappears, the mean basal serum menopausal gonadotropin levels in the range of from 50,150 rn LU / ml FSH and 50 100 m IU/ml LH. FSH level is 15 times higher than premenopausal level 3 5 years after menopause, while LH level is increased three fold. Prolactin decreases.


The process of climacteric can gradually begin 2 3 years before menopause but can continue after two 5th year. The age at which menopause occurs varies greatly 40-55 years with an average age of around 47 years. Hereditary cosmetics, race, and atmosphere impact the age of menopause. Women in the tropics get earlier menopause than in colder climates. Some believe that the onset of the menarche begins; the later would be the menopause, while the late arrival of the menarche is associated with early menopause. Early or delayed is considered menopause when menopause happens before age 35 or after 55 years, individually. Early menopause might be because of ovarian disappointment, oophorectomy or then again ovarian light. Deferred menopause is more often than not due to a number of jaws pathology such as uterine fibroid or in co-operation with the illness, for instance, diabetes mellitus.

Clinical features of the menopause and menopausal symptoms

Menstruation problems

This is done in form of (a) progressive loss scanty menses followed by cessation of menses, (b) eventually stop menses at prolonged intervals, (c) sudden stopping of menstruation. Prior to menopause, menstrual cycles are anovulatory. Any excessive menstrual loss or irregular bleeding is not the menopause such as believed, in general, by laying the public but is due to a number of pelvic pathologies.

Other symptoms

Most women remain asymptomatic. They nicely fit the physiological changes of the menopause. Some may have mild symptoms of putting on weight, joint pain, increased sexual desire, followed by the gradual decrease.


The following symptoms occur gradually in a normal woman in menopause period, and thereafter.

  1. General characters. Weight gain, deposition of fat on the hips, buttocks, breasts around. Breasts are examined.
  2. Genital plates.


Progressive atrophy with insufficient hair with narrowing of the vaginal introitus.

Vagina. This is narrow with 'testing' vaginal vault, thinning of the mucous membranes and 18ss of rugae.


Portion virginals atrophy and rinsed with vaginal vault.


Body felt small and hard.


Ovaries elusive.


These can be made of clinical signs aided by atrophic vaginal swab and elevated serum FSH level of 50 mIU / ml and higher. Elevated plasma LH levels are less useful. Urine or serum estrogen level shows value similar to follicular phase and thus less reliable for the diagnosis.

Differential diagnosis

Cessation of menstruation can be simulated as a result of menopause by that due to pseudocyesis or pregnancy.

Therapy. Psychotherapy.

Explanations for the condition and assurances must be given to women who are menopausal symptoms in seeking advice for stopping of menstruation. Improving health through diet modification, adequate rest and exercise and regular evacuation must be assured of the intestine. For sleep disorders, diazepam (Valium) 5 mg. Lorazepam or 1 or 2 mg. is taken orally at bed time.


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Lesson Intro Video

(Next Lesson) Lesson 2: Menopause and Climacteric Syndrome
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