Menopause is defined as permanent cessation of menses (at least 12 months of amenorrhea).
There is a ‘depletion of ovarian follicles’, which leads to a decrease in ovarian hormones.
- Natural – occurs at or after 40 years of age
- Induced – chemotherapy, pelvic radiation, hysterectomy, bilateral salpingo-oophorectomy
- Post Menopause – dating from final menstrual period, regardless whether menopause was natural or induced. It lasts for about 10-15 years.
- Premature Menopause – it occurs before 40 years & it is not surgical.
Stages of Menopause
- Stage I – From the onset of periomenopausal symptoms (menstrual irregularities & vasomotor symptoms) to cessation of menses.
- Duration – 3-5 years
- Symptoms – menstrual irregularities
- Early psychomotor symptoms
- Vasomotor instability
- Stage II – 5 years after cessation of menses
- Stage IIA – 1 year after cessation of menses
- Symptoms – vasomotor instability
- Urethral Syndrome
- Stage IIB – from stage IIA up to 4 years
- Symptoms: Atrophic changes, vaginitis, dyspareunia, urinary symptoms, weightgain, skin & hair changes, genital prolapse, sexual disorders, late psychological symptoms
- Stage III – From 5 years after menopause up to an indefinite period, probably lifetime
- IIIA – residual atrophic symptoms
- IIIB – stage of ischemic heart disease & early osteoporosis
- IIIC – cerebrovascular changes & Alzheimer’s disease
Hot Flushes (Night sweats)
- They interfere with sleep & lead to insomnia, irritability, tiredness & forgetfulness.
- If it interferes with daily routine activities, you should consult your gynecologist.
- Avoid smoking, alcohol, caffeine, spicy foods, beverages
- Reduction of stress-yoga, meditation, paced breathing
- Stay in cold environment
- Use cotton clothes & sheets, bath in cold water – hypnosis
- Weight loss
- Exercise – weight bearing & aerobics exercises
If not improved with life style modifications, consult your gynecologist.
Osteoporosis & Increased Fracture Risks
- At menopause, loss of bone mass (approx. 3%/year) for first 5 yrs and thereafter 1-2 yrs
- Risk of fracture of
- Spine (30% of spine fractures go unnoticed)
Prevention of Osteoporosis
- Life style modification
- No smoking
- Calcium 1200-1500mg/d
- Vitamin D 400-600 IU/day
- Weight bearing & resistance exercises
- Exercise to strengthen back muscles – to prevent kyphosis, wrist muscles to prevents fractures of wrist, thigh & buttock muscles & to prevent fracture of hip, quadriceps muscle to prevent buckling of knee
Recommendations for menopausal woman
- Calcium 1200-1500 mg/d
- Vitamin D3 – 600 IU/d
- Transvaginal USG
- Pap’s Smear – every year till age of 50 years
- BSE (Breast Self-Exam) – from age of 20
- CBE (Clinical Breast Exam) – every 3 yrs till 40 yrs
- CBE + Mammogram – every year after age of 40
- Mammography before 40 yrs
- F/H of breast cancer
- Nullipara (multipara)
- Elderly Primigravida
- Early menarche & late menopause
- 30-min aerobic exercises for cardiorespiratory fitness (all days in a week)
- Weight bearing, strength training (resistance exercises) 2-3 times/week, balance training for fall prevention – to prevent osteoporosis & sarcopenia