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By Dr Kihara
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Defnition: is the cessation o the menstrualperiod. It heralds
the transition romreproductive capability to incapability.
The premenopausal period to thepostmenopausal period is
termed as
CLIMACTEIC and can last up to !" years.
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Causes o menopause!. #hysiolo$ical a$ein$ o the ovaries
%. #atholo$ically induced menopause
#remature ovarian ailure adiation
Cytoto&ic therapy
'ilateral oophorectomy
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#hysiolo$y o menopause(ypothalamic pituitary ovarian
a&is
elaborated.
)ith the a$in$ o the ovaries there is reductionin the production
o the se& steroidsprincipally estro$en and the ollo*in$
occurs:
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!. Menstrual irre$ularities due to anovulation.
%. Chan$es in the circulatin$ levels o se&steroids+ inhibin
and pituitary $onadotrophins.
,. Decrease in the ertility rates.
-. euroendocrine chan$es o thermore$ulation+sleep patterns+ mood
and behavior /vasomotor
e0ects1.". Eventually the cessation o menstruation and
the clinical e0ects o d*indlin$ se& steroids.
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Clinical picture o the climacteric
#roblems associated *ith estro$en defciency
2ta$e I
Chan$es in the menstrual cycle
(ot 3ushesi$ht s*eats
Insomnia
Depression
Mood chan$es
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2ta$e II 4 Intermediate
5ro$enital atrophy
Dyspareunia / painul6 di7cult se&ualintercourse1
Dysuria /painul6 di7cult urination1
2tress incontinence
28in chan$es
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2ta$e III 4 Late
9steoporosis
Cardiovascular diseaseAlheimer;s disease
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Management(istory
#hysical e&amination
'aseline investi$ationsDia$nosis
Treatment 4 The essence o a *oman
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!. elieve early symptoms.
%. educe intermediate and lon$ term
conse=uences.,. Enhance vitality and =uality o lie.
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9ptions to treatment!. eassurance
%. (ormonal replacement therapy
This should be $uided by the presence o theuterus >6?
cyclical bleedin$+ Absence o theuterus and the ovaries
,. #resence o se&ual dysunctions andtreatment
-. Ad@uvant therapy 4 utrition+ vitaminsupplements and herbal
therapy+ e&ercise
".2upport rom partner+ the amily members andcommunity.
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