Menopause

Menopause Symptoms, Causes, Timeline, and Menopause Treatment in Dubai, Abu Dhabi, Sharjah UAE. Menopause Signs, Menopause Home Remedies and More. Menopause Age, Early Peri/Post Symptoms & Treatment

Menopause Symptoms, Causes, Timeline, and Menopause Treatment in Dubai, Abu Dhabi, Sharjah UAE. Menopause Signs, Menopause Home Remedies and More. What are the early signs of the menopause? What are the signs that you are going through menopause? What are the 34 symptoms of menopause? Can you still have an Orgasim after menopause? What happens to the body after menopause? Can periods start after menopause? Menopause Symptoms and tips. In this animation you will learn more about the menopause. Why do women face menopause? What are typical symptoms and complications? Finally, you will get some tips to relieve the complaints and hormone replacement treatment is described.

Menopause Definition

Menopause refers to final cessation of menstruation while climacteric means the period at which the woman gradually changes from the reproductive life into one of senescence. Meno¬pause is also referred by the laity as ‘the change of life’. However both the terms are often synonymously used, menopause being the popular term used. These are physiological processes due to cessa¬tion of ovarian follicular function.

Aetiology. Menopause occurs as result of exhaustion of eggs from ovarian follicles and Consequent oestrogen deprivation.

Physiological Changes in Climacteric or Menopause and Post menopausal age.

Genital. Progressive atrophy of genital organs occurs with more and more deposition of fibrous tissue in them.

Ovary. They go small (5 gm. each), fibrotic with furrowed surface, Follicles get exhausted. Ovarian Vessels become sclerosed. Cortical stromal hyperplasia is a frequent finding due to high LH level in women aged 40¬46 years. Ovarian stroma becomes a source of small amount of androgens.
Fallopian tubes shrink with diminished mortility.

Uterus becomes small and fibrotic due to atrophy of muscle. Endometrium becomes thin and atrophic (senile). In some women, endometrial. hyperplasia may occur after menopause as a result of constant oestrone stimulation. Cervix atrophies and flushes with the vaginal vault. Cervical secretion becomes scant, thick and later 4isappears. The vaginal epithelium atrophies with loss of rugosity. Vaginal smear shows atrophic changes. Vagina contracts with shallowness of the fornices. Vulva gradually atrophies with narrowing of the introitus : pelvic cellular tissue becomes gradually lax.

Menopause Symptoms, Causes, Timeline, and Menopause Treatment in Dubai, Abu Dhabi, Sharjah UAE. Menopause Signs, Menopause Home Remedies and More. Menopause Age, Early Peri/Post Symptoms & Treatment

Secondary sex characteristics. Breasts show gradual atrophy of the glandular tissue resulting in flabbynes. These become pendulous due to deposition of fat around. Pubic and axillary hair becomes sparse.

Physical. Body weight decreases after 65 years. There is decrease in cell mass of organs. Skin wrinkles, becomes less elastic with hair appearing on face. Subcutaneous fat deposition. occurs on the hip and thighs. Height diminishes postraenopausally after 65 years. Kyphosis may develop due to spinal osteoporosis.

Metabolic. Osteoporosis occurs as a result of oestrogen deprivation. Reduction in trabecular bone (collagen matrix) (Osteoblasts) and Calcium leads to oestrogen deprived Osteoporosis. Premenopausally woman is protected against ischaernic heart disease due to high HDL and low LDL cholesterol. The latter rises postmenopause, thus incidence of ischaernic heart disease also rises. Premature menopause natural or by oophorectomy suffers from increased risk of cardiovascular diseases (cardiac and cerebral stroke) and osteoporosis.

Digestive. Hypochlorhydria develops. Motor activity of entire alimentary tract diminishes resulting in dyspepsia and constipation in postmenopausal women. Bladder and urethral epithelia atrophy.

Psychosexual. Emotional upsets are common. At menopause sex urge may increase. After 60 years, sex urge wanes as an aging process.

Endocrinal. There is gonadal failure at menopause. Plasma Oestradiol level falls, oestrone remains normal, ovarian stroma however, produces andostenedione. Extraglandular conversion of androstenedione to oestrone occurs in fatty tissue. Postmenopausally, adrenal cortex becomes the source of oestrone derived from androstenedione. Oestrone becomes the predominating oestrogen after menopause. Postmenopausal daily oestrone formation has been estimated as 15 100 gg/day (Mac Donald et al, 1973) and serum level at 30 70 pg/ml. Progesterone secretion ceases from the ovary due to failure of ovulation. Total urinary oestrogen level falls to about 6 Pg1 24 hours at the postmenopausal period. Androstenedione level mostly from adrenal cortex, little . from ovary comes to one half that seen prior to menopause. Testosterone level does not appreciably fall because postmenopause ovary secretes more testosterone.

Pituitary gonadotrophins. FHS and LH are secreted in increasing amount due to the absence of negative feed back control by the ovarian steroids. LH ovulatory surge disappears, the mean basal serum menopausal gonadotrophin levels are in the range of 50 150 rn LU/ml FSH and 50 100 m IU/ml LH. FSH level is 15 times higher than premenopausal level by 3 5 years after menopause while LH level is increased 3 fold. Prolactin level falls.

Timing. The process of climacteric may gradually start 2 3 years before menopause but may continue 2 5 years after it. The age at which menopause occurs varies widely from 40 to 55 years with mean age of about 47 years. Genetic makeup, race and climate influence age of menopause. Women of tropics get earlier menopause than those in colder climate. Some believe that the early the menarche starts, the later would be the menopause while late coming of the menarche is associated with early menopause. Early or delayed menopause is considered when menopause happens before 35 years or after 55 years respectively. Early menopause may be due to ovarian failure, oophorectomy or ovarian irradiation.

Delayed menopause is usually due to some pelvic pathology like uterine fibroid or in association with disease e.g., diabetes mellitus. Clinical Features of Menopause and climacteric

Menstrual Symptoms. This occurs in forms of (a) progressive scanty menstrual loss followed by cessation of menses, (b) menses at prolonged intervals finally ceasing, (c) sudden cessation of menses. Prior to menopause menstrual cycles become anovulatory. Any excessive menstrual loss or irregular haemorrhage is not menopausal as in commonly believed by lay public but is due to some pelvic pathology.

Other symptoms. Most women remain asymptomatic. They adapt nicely the physiological changes of menopause. Some may have mild symptoms of putting on weight, joint pains, increase of sex desire followed by its gradual decrease.

Menopause Signs

The following signs appear gradually in a normal woman in the menopausal period and thereafter.

1. General signs. Increase in weight, deposition of fat on the hip, buttocks, around breasts. Breasts are examined.

2. Genital signs.
Vulva. Progressive atrophy with scanty hair with narrowing of the vaginal introitus.
Vagina. This becomes narrow with ‘tenting’ of vaginal vault,, thinning of mucous membrane and 18ss of rugae.

Cervix. Portio vaginalis atrophies and gets flushed with vaginal vault.
Uterus. Body is felt small and hard.

Adnexae. Ovaries become impalpable.

Diagnosis. This can be made from clinical features aided by atrophic vaginal smear and elevated serum FSH level of 50 mIU/ml and above. Elevated plasma LH level is less helpful. Urinary or serum oestrogen level shows value similar to follicular phase and thus less reliable for diagnosis.
Differential Diagnosis. Stoppage of menses due to menopause may be simulated by that due to pseudocyesis or pregnancy.

Treatment. Psychotherapy. Explanations for the condition and reassurances are to be given to the woman passing through climacteric when seeking advice for cessation of menses. Improvement of health by dietetic adjustment, adequate rest and exercise and regular evacuation of bowel are to be ensured. For sleep disturbance, diazepam (Valium) 5 mg. or Lorazepam 1 or 2 mg. is taken orally at bed time.

Menopausal or Climacteric Syndrome

Menopausal Syndrome refers to group of symptoms that are experienced by some women during climacteric. Hot flushes (vasomotor instability symptom) that last for one year in 80% are characteristic of menopausal syndrome. It diminishes of its own by 3 4 years. The cause of hot flush is unclear but follows oestrogen withdrawal in women with poor vascular control. Rise of hypothalamic endorphin is implicated. It is experienced by, 25% women with psychological background, particularly following oophorectomy or ovarian irradiation at younger age.
Flush depends on rate of oestrogen loss and extragonadal oestrone formation. The body gradually adjusts itself to natural decline of oestrogen and flushes gradually pass off.
Symptoms. These appear as follows: vasomotor and other symptoms usually follow but even precede cessation of menses.

1. Menstrual. Menses stop as already described under menopause. A proportion of premenopausal women come with emotional symptoms, loss of libido and dry vagina during intercourse, Hot flushes and sweats are complained with scanty and delayed menses by some women.

2. Vasomotor. ‘Hot flushes’ (feeling of warmth) due to cutaneous vasodilatation are commonly experienced by these, women on the face and neck spreading all over the body; this feeling of heat may be followed by sweating. They may come once a day but sometimes every hour; they come particularly at night. These are characteristic manifestations of menopausal syndrome.

3. Emotional. This is manifested by headache, irritability, sleeplessness, giddiness, fatigue, depression, palpitation. There may be sensations of ‘pins and needles’ in the sole and palm. Disturbed sleep can be due to hot flushes and sweats.

4. Sexual. These are decreased libido and dyspareunia due to atrophic vaginitis and lack of vaginal lubrication during intercourse.

5. Musculoskeletal. These appear as backache, pain in joints due to laxity of ligaments and muscles.

Signs. These are same as described under menopause.
Diagnosis. This has been already described under menopause.

Differential Diagnosis. Pseudocyesis of spurious pregnancy may be mistaken by the patient for menopausal syndrome. In the former, amenorrhoea, enlargement of breasts and abdomen due to deposition of fat like that in pregnancy occur; there is also the false feeling of foetal movements due to flatulent dyspepsia. The patient should be assured that her symptoms are menopausal. In all these cases, pregnancy may also occur and should be carefully excluded by thorough examination, immunological urinary pregnancy test and pelvic ultrasound.
Premature Menopause

Definition. Menopause coming on a patient below 35 years is called premature menopause. Cause. Poor stock of ovarian follicles gets exhausted. Clinical Features, Symptoms, Secondary amenorrhoea for more than 6 months. In some hot flushes, mood instability, disturbed sleep, loss of libido, (menopausal syndrome). draying of hair. Signs. Atrophic vaginal epithelism, normal or small sized uterus. Investigations. Raised serum FSH above 50 mIU/ml.; ovarian biopsy showing no ovarian follicles is not done. Treatment Assurance, diazepam for poor sleep. Oestrogen therapy for menopausal syndrome are given. Menstruation can not be brought on hormone therapy.

Male Climacteric. About 10 per cent men experience climacteric symptoms at a later age than women due to androgen deprivation. The rest 90 per cent gradually adapt themselves without symptoms.

Treatments available for menopause

Menopause is a normal part of life that cannot be combined with a disease. However, the treatment of related symptoms is possible so can be taken into consideration.

1. Hormone therapy (Estrogen and progesterone therapy)

Hormone Therapy (HT) or Hormone Replacement Therapy (HPT) or Postmenopausal Hormone Therapy (PHT) is a treatment that administers doses of both estrogens and progesterone. It is administered in order to prevent the symptoms associated with declination of estrogen levels like hot flashes and vaginal dryness and is still the most effective treatment available but studies have indicated that the women receiving HT have increased risk of breast cancer, heart attacks. Women receiving only estrogen therapy also have higher risk of endometrial cancer.

Hormone therapy is available in the form of oral pills and transdermal forms. Transdermal hormone products are already in the active form so they don’t have to get converted into activated form in the liver. As these products have no effect on the liver they are prescribed for majority of the females. There has been an emerging interest among the researchers for the use of a bio-identical hormone for the perimenopausal women. These hormones have same chemical compositions like those produced naturally inside the body. These products are prepared in the laboratory from the naturally derived plant products and are approved by the U.S.FDA so are in market. They are also used transdermal in the form of creams or gels. The use of hormone therapy is based on the decision of both the patient and the doctor.

2. Oral contraceptive pills

Oral contraceptive pills are other form of hormone therapy that is prescribed to the females undergoing perimenopause in order to treat irregular vaginal bleeding. Before prescribing these pills the doctor must check that whether the irregular vaginal bleeding is due to perimenopause or some other factors are associated with it. These do not provide relief from hot flashes but prevent a female from becoming pregnant.

3. Local hormone and non-hormone treatments

Vaginal estrogen deficiency is also treated with the local hormonal treatments. These include vaginal estrogen ring, vaginal estrogen cream or vaginal estrogen tablets. Local and oral estrogen treatments are sometimes combined. Vaginal moisturizing creams or gels or use of lubricating agents during intercourse are non-hormonal agents used to prevent vaginal dryness. Application of Betadine topically on the outer vaginal area or soaking in a bathtub or warm water may also relive the symptoms of vaginal pain or burning sensation after sexual intercourse.

4. Antidepressant medications

Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs most frequently used to control the symptoms of hot flashes and have given positive results in 60% of the women. The common examples of these drugs include venlafaxine, citalopram, fluoxetine, paroxetine and sertraline. However, antidepressants are associated with some side effects like sexual dysfunction.

5. Plant estrogens or phytoestrogens or isoflavones

Isoflavones are chemical compounds present in soy and are plant derived estrogens. The structure of these plant estrogens is exactly similar to those produced in the body but their effectiveness is somewhat lower in comparison to the body estrogens. Their estrogen potency is estimated to be about 1/1,000 to 1/100,000 of that of natural estrogen. Two types of isoflavones namely, genistein and daidzein have been derived from soybeans, chickpeas and lentils that are considered to be the most potent phytoestrogens. Some studies have shown that these compounds help in relieving hot flashes and other symptoms of menopause. Women suffering from breast cancer are also prescribed these phytoestrogens if they do not want to undergo hormone therapy (HT) during menopause transition. Some researchers have however shown that excessive intake of these plant derived estrogens result in over-growth of the tissues lining the uterus which can result in the development of cancer.

6. Vitamin E

Some women have reported that intake of vitamin E supplements can also help in relieving hot flashes but this fact lacks scientific support. Taking a dosage of greater than 400 IU of vitamin E is not safe as it increases the risk of cardiovascular diseases.

7. Black Cohosh

Black cohosh is an herbal preparation popular in Europe often prescribed against hot flashes. The North American Menopause Society does not support the short term usage of this herbal preparation

8. Non-pharmaceutical therapies

Survivors of breast cancer or females not interested to take oral or vaginal estrogens are prescribed vaginal lubricants however, they are not very effective.
So it can be concluded that menopause is a natural state of body and the symptoms can be controlled by the medications mentioned above.

Menopause Symptoms, Causes, Timeline, and Menopause Treatment in Dubai, Abu Dhabi, Sharjah UAE. Menopause Signs, Menopause Home Remedies and More. What are the early signs of the menopause? What are the signs that you are going through menopause? What are the 34 symptoms of menopause? Can you still have an Orgasim after menopause? What happens to the body after menopause? Can periods start after menopause?

Menopause Symptoms, Causes, Timeline, and Menopause Treatment in Dubai, Abu Dhabi, Sharjah UAE. Menopause Signs, Menopause Home Remedies and More. Menopause Age, Early Peri/Post Symptoms & Treatment

Menopause Symptoms, Causes, Timeline, and Menopause Treatment

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Menopause Symptoms, Causes, Timeline, and Menopause Treatment in Dubai, Abu Dhabi, Sharjah UAE. Menopause Signs, Menopause Home Remedies and More.

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