dMenopause Definition:- Menopause is defined as the time at which menstruation ceases. Climacteric:- is the phase of waning ovarian activity and may start two or three years before the menopause and continue for two to five years after it . The climacteric is thus a phase of adjustment between active and inactive ovarian function and may occupy several years of women’s life. Menopause occurs between the ages of 45 and 55 years the average age being 47 years. Menopause before the age of 40 is called premature menopause. Late menopause is also common in women suffering from uterine fibroids and in the prone to endometrial carcinoma. Phisiology :- During climacteric , ovarian activity declines. Thus the menstrual cycles tend to become an ovulatory and irregular Harmonal levels:- Once menopause is well established, plasma oestrogen level may remain low at 10 – 20 pg/ml. Oestrone level varies between 30 and 70 pg/ml. The ovary also secretes a small amount of testosterone -responsible for mild hirsuitism noticed after menopause. The genodotrophin harmone appears in high concentration at menopause. Menopausal Symptoms:- In majority , apart from cessation of menstruation, no more symptom is evident. 1)Menstrual:- The three classical ways in which the period ceases are a)Sudden cessation. b)Gradual diminution in the amount of blood loss with each regular period until menstruation stops . c)Gradual increase in the spacing of the periods until they cease for atleast an interval of 6 months. 2)Cardiovascular :- The commonest symptoms are hot flushes and sweating which are the hall mark of the climacteric in 85 % of women. The functional derangements of cardiac action causing palpitations are common and angina pains of effort are complined of at this time. 3)Neurological and Emotional :- Paraesthesia , which takes the form of sensations of pins and needles in the extremities is common .Headaches and noises in the ears of complained of ,while physical disturbances which the form of irritability , depression and even melancholia are frequent . The condition of pseudocyesis is infrequent. 4) Locomotor system:-Menopausal arthropathy , osteoarthritis , fibrositis , back ache,and vertebral disc lesions are all common complaints at menopause. 5)Osteoporosis :- Bone resorption follows oestrogen deficiency after menopause. 6)Urinary tract:- Menopause causes urethral caruncle , burning micturition without infection and stress incontinence due to poor vascularity around the internal urinary sphincter . These symptoms are clubbed together under the term urethral syndhrome. 7)Endocrine system:- Slight virilisation as seen in the increased hirsutism is probably adrenal in origin . Slight degrees of hypothyroidism are also noticed with low BMR , raised colestrol ,brittleness of hair, dryness of skin , lassitude and reduction of mental power and concentration. Genital tract:- a)Vulva:- The vulval skin becomes pale , thin and almost transulent. b)Vagina:- becomes dry ,epithelium atrophic ,glycogen is low , PH rises and senile vaginitis is common . c) Cervix:- An obliterative stenosis may result in senile pyometra. d)Uterus:- this diminishes in size and fibroids if presents shrink in size but donot disappear. e)Ovaries:- Ovaries atrophies with gradual decrease in oestrogen production. Investigations:- 1)History. 2)General examinitation – blood pressure , weight , Hirsutism. 3)Breasts , per abdomen and vaginal examinitation - mammography as needed. 4)ECG if indicated , X –ray chest . 5) Bone study as needed . 6)pap smear. dermatology billing services will understand all these in detail. Management:- Non hormonal treatment Nutritious diet-balanced with calcium & protein is helpful Dietary intake of 800-1000mg can reduce osteoporosis & fracture. Exercise –walking & jogging. Vit D supplementation-400 Iu/day along with calcium can reduce osteoporosis and fractures.

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