THE

CLIMACT-
ERIC

DR. AMBER TARIQ

MS-NMPT (RIU)
DPT (UOL)
INTRODUCTION

– Menopause is last menstrual flow experienced by woman.

– 45-55 years
– Race, economic status and nutrition
– Differentiate between normal variations and signs of disease e.g. bleeding that
occurs for more than 1 year after menopause is postmenopausal bleeding,
indicative of some pathology
– Premenopausal (when periods are erratic)
– Perimenopause (unpleasant symptoms experienced by women during this time)
– When a woman proceeds from fertile to infertile years that is termed as
CLIMACTERIC.
– These changes occur because the ovaries become exhausted, shrink and fail to
produce estrogen.
– Anterior pituitary is then released due to cyclic inhibition of estrogen and so
continues to produce FSH and LH
– CHANGES AFTER MENOPAUSE :
– Gradual atrophy of all the target organs
– Involution of breast structure and cessation of breast cyclic changes
– Ovaries shrink
– Uterus becomes smaller
– Endometrium shows atrophic changes and becomes thinner
– Cervix diminishes in size and its secretion also decreases
– Atrophy of vaginal wall with loss of elasticity
– Fall in acidity of secretions within vagina, making it more prone to infection
– Vulvitis (Infection of vulva)
– Pubic hair decreases
– Atrophy of epithelium of bladder
PHYSICAL SYMPTOMS

– Hot flushes & night sweats

– Vaginal soreness
– Urinary disorders
– Dry skin
– Psychological & Emotional symptoms
HOT FLUSHES & NIGHT
SWEATS

– Flushing & sweating occur usually over the upper chest, neck & face
– Triggered by stressful situation such as hot drink or hot spicy food
– Pulse rate rises
– Palpitations may occur
– Women may waken in night soaked in perspiration, often needing to change
their nightwear
– These symptoms are known to be associated with low levels of estrogen in the
blood and may also be due to rise in levels of FSH & LH
– HRT but may return as soon as it is stopped
VAGINAL SORENESS
(ATROPHIC VAGINITIS)

– Vaginal & cervical secretions are decreased and becomes less acidic
– Vaginal lining becomes thin, dry & less elastic
– More prone to infection & vulnerable to soreness, irritation, burning and
discharge
– Narrowing of introitus and dyspareunia with consequent marital stress
– These all may respond well to administration of estrogen
URINARY DISORDERS

– Urogenital problems associated with vaginal delivery predisposing a woman to

the development of urinary incontinence (stress or urge) or prolapse or both
– Not only vaginal delivery can cause urogenital problems but also may be caused
by menopause when declining ovarian function results in estrogen depletion
– Atrophy, inflammation and infection of vagina
– Urethritis
– Urethral syndrome (cystitis, urethritis, frequency, urgency and dysuria following
the climacteric; this cluster of urogenital symptoms presents postmenopausally)
DRY SKIN

– Due to chronic UV radiation exposure

– Reduction in epidermal cell turnover rate (up to 50% reduction by the age of 70)
resulting in decreased ability of the skin to withstand and repair damage
– HRT administered in postmenopausal woman results in increased dermal
thickness and content of collagen increases
– Decrease in estrogen is partly responsible for dryness, thinning and reduced
elasticity of skin
PSYCHOLOGICAL &
EMOTIONAL SYMPTOMS

– Cholinergic neurons in brain contains estrogen receptors so decline in estrogen

level in postmenopausal women results in impaired cognitive performance and
increased incidence of dementias
– General loss of well being and diminished quality of life
– Other life stresses in age of 40s or early 50s
SEXUALITY IN THE
CLIMACTERIC

– Decline in estrogen and testosterone (latter being associated with decreased

sexual desire, sensitivity and response)
– Postmenopausal atrophic urogenital effects interfere mechanically with sexual
comfort & pleasure, and disease and associated medications may also
negatively affect sexuality
– May be coped up by treatment and psychologically the loving support of an
understanding partner (that may help to reduce a woman’s anxiety)
– Testosterone levels in male begin to fall around the 40s resulting in a decline in
libido, physical performance and decreased sexual activity. These symptoms are
collectively called as andropause syndrome
– Erectile dysfunction is defined as the inability to achieve & maintain a penile
erection adequate for satisfactory sexual intercourse
– Androgen deficiency is a part of normal ageing process but there are other
independent factors which may contribute to ED, including radical pelvic
surgery, diabetes, alcohol and smoking, certain medications for HTN &
depression & performance anxiety
POSTMENOPAUSAL
PROBLEMS

– Notable sequelae of lowered estrogen levels results in significant morbidity &

mortality
– Most common effect of estrogen depletion is Osteoporosis
– Increased risk of CVS disease
CARDIOVASCULAR DISEASE

– Biggest killer of postmenopausal women in western society

– 1 in every 2 women who reaches the age of 50 eventually die of heart disease
or stroke
– Estrogen replacement therapy confers protection against CVD and reduces the
risk
– Estrogen & progesterone replacement therapy with different doses & different
routes of administration