The Elderly And Menopause

The Elderly And Menopause
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.
Menopause
  • 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.
Lifestyle Modification
  • 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
  • Acupuncture
  • 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
    • Wrist
    • Hip
    • 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
  • Mammography
  • 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
  • Obesity
Exercises
  • 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