Menopause

Dr/ Eman Abd Elfatah

Menopause
• Climacteric: Period of time during which the
female pass from reproductive to non-
reproductive stage.

• Menopause: the physiological and permanent

cessation of menstruation( for 6 months or
one year) due to failure of ovarian function
Menopause age
 Types of menopause
• 1- Natural : the body reacts to dropping levels
of estrogen and other hormones.
•
• 2- Artificial:- Surgical menopause may follow
an oophorectomy (removal of an ovary or
both ovaries), or radiation
 Common menopausal symptoms
• 1- menstrual irregularities, amenorrhea
• 2- hot flash, night sweats,
• 3- mood swing,
• 4- insomnia,
• 5- vaginal dryness,
• 6- urinary problems,
• weight gain, memory & cognitive change and
fatigue
• Trunk obesity: The low estrogen levels in the
late stages of menopause may also impair the
function of leptin
• Estrogen affect the site of deposition of fat
• Atherosclerosis :
• estrogen maintain elasticity of vascular tissue
 Hot flashes
• Transient recurrent period of heat sensation
and redness associated with sweet, increase in
temperature in face, neck head and breast
accompanied by anxiety palpitation affect
sleep pattern
• Decrease level of estrogen and increase level
of FSH
 Changes during menpouse
• Breast: Atrophied and pendulous shape
• Genital system :Atrophy of ovary , uterus and
epithelium of the vagina make dryness and
dyspareunia
• PFM has receptor to estrogen level
• Less tone and liable to stress incontinence
 Osteoporosis and Menopause
• decrease in the bone mineral density (BMD) in
which the bone matrix and minerals are lost
due to an excessive bone reabsorption
• Affect trabecular bone than cortical bone
• Increase osteoclast and decrease osteoblast
 Bone remolding
• bone remolding: The osteoblasts are
responsible for the synthesis and the
osteoclasts for reabsorption of the bone
• 30 years of age, bone mass declines gradually
at rate of approximately 0.4% per year until
the menopause. With menopause, there is a 1
to 1.5%of total bone mass may occur.
 Types of osteoporosis
• Primary osteoporosis is the deterioration of
bone mass that is unassociated with other
chronic illness
• related to aging and decreased gonadal
function, prolonged periods of inadequate
calcium intake, sedentary lifestyle and tobacco
and alcohol abuse also contribute to this
condition
• Secondary osteoporosis results from chronic
conditions. These chronic conditions include,
hyperparathyroidism, malignancies,
gastrointestinal diseases
 Diagnosis of osteoporosis
• (DEXA)scan is low levels of X-rays can measure
the bone mineral density of skeleton, as well
as specific points that are more likely to break
• A score above -1 is considered normal.
• -1 to -1.5 borderlines
• less than- 2.5 is osteoporosis
Dexa
 Management of osteoporosis

• (A) Pharmacological treatment:

• calcium (generally 500 to 1000 mg/day),
• 800 IU of vitamin D daily
 Aerobic exercises
• Exercise can also improve gait, balance,
coordination, proprioception, and muscle
strength, decrease truckle obesity and
decrease incidence of cardiovascular disease

• Aerobics decrease incidence of hot flashes

and depression in post menopausal women
Acupuncture point for hot flashes
• localized, (Sanyinjiao (sp6), Hegu (LI.4), Quchi
(LI.11), Fengchi (GB.20.), Guanyuan (CV 4.)
and Fuliu (KI7))
Biochemical effect of exercise on bone
• Regular weight-bearing exercise stimulates
bone formation and suppresses bone
resorption
• increase calcitonin hormone decreases the
serum parathyroid hormone
• Increase sex hormone bonding globulin and B
estradiol hormone
 Piezoelectric effect of exercises
• Physical training increase mechanical load on
bone and increase bon mass
• Bone has piezoelectrical potential (capacity of
bone to transform mechanical signs into
electrical signs which stimulate bone cellular
activity and mineral deposition on the stress
points caused by ms contraction
Pulsed electromagnetic field
 Pulsed electromagnetic field
• increasing alkaline phosphatase-specific
activity, calcitonin synthesis, and collagen
production.
• with 10 micro volt /cm and frequency
between 50-150 HZ for 1 hour /day can
slowing bone loss
• Ultrasound
• Scanner LLLT
 Post natal complication
• Coccydenia
• Ligament injuries or displacement of the
coccyx
• Inflammation in ability to maintain sitting
position
• Treatment : US , PEMF, coccyx mobilization
• Gluteal ms contraction
 After pain
• Pain due to uterine contraction to return to
normal site and size (involution)
• Increase in multiparous women
• May sustain 3-4 days after delivery
• Increase with lactation
• Treatment :: TENS
• Relaxation on face position
 Breast engorgement
• Due to accumulation of milk in breast
• Pain with lactation
• Treatment
• Heat application before lactation
• Ice application after lactation
• Ultrasound from peripheral toward nipple
•
 Blocked duct
• Non infected mastitis
• Pain tenderness , redness in one area in breast
• Continuous US , frequency 1 MHz2-3 minutes
• Intensity 1.5-2 W/cm
 Cracked nipple
• IR for 10-15 minutes
• Scanty of milk
• scanner LLLt with wave length 6328
• Power 25 mw for 10 minutes daily for 10 days
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