MENOPAUSE

NESTAN BOSTOGANASHVILI. FACULTY OF DENTISTRY

MENOPAUSE
also known as the climacteric, is the time in most women's lives when
menstrual periods stop permanently, and they are no longer able to bear
children. Menopause typically occurs between 49 and 52 years of age. Medical
professionals often define menopause as having occurred when a woman has
not had any vaginal bleeding for a year. It may also be defined by a decrease in
hormone production by the ovaries. In those who have had surgery to
remove their uterus but they still have ovaries, menopause may be viewed to
have occurred at the time of the surgery or when their hormone levels fell.
Following the removal of the uterus, symptoms typically occur earlier, at an
average of 45 years of age.
MENOPAUSE
Before menopause, a woman's periods typically become irregular, which
means that periods may be longer or shorter in duration or be lighter or
heavier in the amount of flow. During this time, women often experience hot
flashes; these typically last from 30 seconds to ten minutes and may be
associated with shivering, sweating, and reddening of the skin. Hot flashes
often stop occurring after a year or two. Other symptoms may include
vaginal dryness, trouble sleeping, and mood changes.
MENOPAUSE

The severity of symptoms varies between women.

While menopause is often thought to be linked to an
increase in heart disease, this primarily occurs due to
increasing age and does not have a direct relationship
with menopause. In some women, problems that were
present like endometriosis or painful periods will
improve after menopause.
VAGINA AND UTERUS

During the transition to menopause, menstrual

patterns can show shorter cycling (by 2–7 days); longer
cycles remain possible. There may be irregular bleeding
(lighter, heavier, spotting).Dysfunctional uterine bleeding
is often experienced by women approaching
menopause due to the hormonal changes that
accompany the menopause transition. Spotting or
bleeding may simply be related to vaginal atrophy, a
benign sore (polyp or lesion).
AGE

In the Western world, the typical age of menopause

(last period from natural causes) is between 40 and 61
and the average age for last period is 51 years. The
average age of natural menopause in Australia is 51.7
years. In India and the Philippines, the median age of
natural menopause is considerably earlier, at 44 years.
 PREMATURE OVARIAN FAILURE
(POF) is diagnosed or confirmed by high blood levels of
follicle stimulating hormone (FSH) and luteinizing
hormone (LH) on at least three occasions at least four
weeks apart. Women who have a functional disorder
affecting the reproductive system (e.g., endometriosis,
polycystic ovary syndrome, cancer of the reproductive
organs) can go into menopause at a younger age than
the normal timeframe.
SURGICAL MENOPAUSE
Menopause can be surgically induced by bilateral oophorectomy
(removal of ovaries), which is often, but not always, done in
conjunction with removal of the Fallopian tubes (salpingo-
oophorectomy) and uterus (hysterectomy). Cessation of menses
as a result of removal of the ovaries is called "surgical
menopause". The sudden and complete drop in hormone levels
usually produces extreme withdrawal symptoms such as hot
flashes, etc. Removal of the uterus without removal of the
ovaries does not directly cause menopause,
 PERIMENOPAUSE

which literally means "around the menopause", refers

to the menopause transition years, a time before and
after the date of the final episode of flow. According to
the North American Menopause Society, this transition
can last for four to eight years. The Centre for
Menstrual Cycle and Ovulation Research describes it as
a six- to ten-year phase ending 12 months after the last
menstrual period.
THE TERM POSTMENOPAUSAL

describes women who have not experienced any

menstrual flow for a minimum of 12 months, assuming
that they have a uterus and are not pregnant or
lactating. In women without a uterus, menopause or
postmenopause can be identified by a blood test
showing a very high FSH level. Thus postmenopause the
time in a woman's life that take place after her last
period or, more accurately, after the point when her
ovaries become inactive.
 ORAL CHANGES AT MENOPAUSE
AND PROSTHODONTIC
IMPLICATIONS
The oral alterations noted at menopause are frequently related to hormonal
changes although a physiological aging of the oral tissues also plays a
contributing role. The following are the oral manifestations noted at
menopause:
Burning mouth syndrome;
Xerostomia;
Mucosal changes;
Neurological disorders;
Osteoporosis and periodontitis;
Eating disorders
 BURNING MOUTH SYNDROME
Burning mouth syndrome (BMS) also known as
glossodynia, stomatodynia, stomatopyrosis,
glossopyrosis, glossalgia represents a common oral
abnormality that manifests as intense pain and
spontaneous burning sensation affecting various areas
of the oral cavity in the absence of any identifiable
organic abnormalities. It is chiefly bilateral and affects
the tongue, lips, palate, gingival, and areas of denture
support.
BURNING MOUTH SYNDROME
According to a study conducted by Wardropa and co-workers,
33% of postmenopausal women studied reported oral
discomfort in the absence of other oral changes. Furthermore,
the prevalence of oral discomfort was found to be appreciably
higher in peri/postmenopausal women than in premenopausal
women (43% vs.6%).Accompanying oral alterations include
disgeusya, dry mouth, dysphagia, and oro-facial/dental pain.
BURNING MOUTH SYNDROME
The underlying etiology remains ambiguous with hormonal changes and small-
fiber sensory neuropathy of the oral mucosa suggested as probable underlying
causes.[6] Variable results have been obtained following treatment of BMS in
menopausal women with hormone replacement therapy (HRT), low-dose
topical/systemic clonazepam, psychological counseling, and tricyclic
antidepressants.
 XEROSTOMIA
Hyposialia, xerostomia or dryness of mouth is yet another symptom
frequently manifested by menopausal women. Although few studies conclude
that salivary flow decreases in menopausal women with increase in salivary
IgA and total proteins, others have not been able to delineate any alterations
in salivary volume/composition. Some studies further implicate decreased
salivary flow as a cause for increased incidence of root caries, oral discomfort,
taste alterations, oral candidiasis, and periodontal disease in menopausal
women. In addition, Sjogren's syndrome an autoimmune disorder leading to
xerostomia, keratoconjunctivitis sicca, vaginal dryness and dyspareunia is
found to occur with a higher frequency in menopausal women.
MANAGEMENT

• includes frequent sipping of water, artificial salivary

substitutes, sugar free-gums/lozenges, xylitol tablets and
sialogogues such as pilocarpine, bromhexine, cevimeline, and
bethanecol. Use of toothpastes, gels/varnishes containing
fluorides is advisable for prevention of dental caries.
Chlorhexidine reduces plaque and enables prevention of
root caries.
MUCOSAL CHANGES
The oral mucosa is in several ways akin to the vaginal mucosa.
The oral mucosal changes may thus range from a condition referred to as
“menopausal gingivostomatitis” to an atrophic pale appearing
mucosa.Menopausal gingivostomatitis is characterized by gingiva that bleed
readily, with an abnormally pale dry/shiny erythematous appearance.
These symptoms necessitate a scrupulous assessment of denture fit and
evaluation of the status of underlying tissues to eliminate chronic irritation.
If fungal culture proves positive, topical antifungal agents such as clotrimazole
or nystatin may provide relief from symptoms. Hormonal therapy with
estradiol in patients with identifiable estrogen receptors at the oral epithelial
level may be beneficial
NEUROLOGICAL DISORDERS

Trigeminal neuralgia is also known to occur frequently in postmenopausal

women owing to compression of superior cerebellar artery on any one of the
branches of trigeminal nerve. The same is characterized by severe unilateral,
lancinating, “electric-shock” like pain usually in the middle and lower third of
the face. Apart from this other neurological disorders such as Alzheimer's
disease and atypical facial pain/neuralgia may affect postmenopausal women.
Neurological disorders influence impression making procedures, jaw relation
records, and denture retention. Thus, employment of anxiety and stress-
reduction protocols is suggested in menopausal women during treatment
procedures.
 OSTEOPOROSIS AND PERIODONTITIS

The susceptibility to progressive periodontitis and osteoporosis enhances

following menopause. The exact pathogenesis remains unclear although
increased accumulation of bacterial plaque and estrogen/serum osteocalcin
deficiency have been suggested as etiological factors.Systemic osteoporosis
leading to generalized bone loss may make the jaws susceptible to advanced
alveolar bone loss, decreased bone mineral density (BMD)
 OSTEOPOROSIS
Women with advanced osteoporosis were thrice more susceptible to be
edentulous than healthy age-matched controls.Thus, the probability of a
Prosthodontist treating menopausal women would be high, making a
knowledge of the oral and systemic symptoms in women of menopausal age
imperative. Methods of diagnosing systemic osteoporosis in postmenopausal
women have been developed by oral and maxillofacial radiologists employing
dental/panoramic radiographs.
OSTEOPOROSIS

Bisphosphonates prevent systemic bone resorption and

decrease the incidence of vertebral and nonvertebral fractures in
postmenopausal women. Alendronate and Risedronate have
found to improve periodontal status in particular. Numerous
cases reports have associated use of bisphosphonates to
osteonecrosis of the jaws. However, according to the doses of
bisphosphonates for treating osteoporosis are recommended by
FDA
EATING DISORDERS

psychological distress in menopausal women may lead to eating disorders.

Oral changes may crop from self-induced vomiting and resultant regurgitation
of gastric contents. Smooth erosion of enamel, perimolysis, enlarged parotid
glands, trauma to oral mucous membrane and pharynx resulting from use of
fingers, combs, and pen to induce vomiting, dehydration, and erythema may be
observed in menopausal women suffering from eating disorders.
• Thank you for attention