Menopause and Climacteric
Definition. Menopause refers to the final cessation of menstruation, while climacteric means the period in which women gradually change from reproductive life to senescence. Lay people also refer to menopause as “the change of life.” However, both terms are often used as synonyms, menopause being the popular term used. These are physiological processes due to the cessation of ovarian follicular function.
Etiology. Menopause occurs as a result of ovarian follicle depletion and consequent estrogen deprivation.
Physiological changes in climacteric or menopause and postmenopausal age.
Genital. Progressive atrophy of the genital organs occurs with more and more deposition of fibrous tissue in them.
Ovary. They become small (5 gm. Each), fibrotic with furrowed surface, the follicles are depleted. The ovarian vessels are sclerosed. Cortical stromal hyperplasia is a frequent finding due to the high level of LH in women aged 40 to 46 years. The ovarian stroma becomes a source of small amount of androgens.
The fallopian tubes shrink with a decrease in mortality.
The uterus becomes small and fibrotic due to muscle atrophy. The endometrium becomes thin and atrophic (senile). In some women, endometrial. Hyperplasia can occur after menopause as a result of constant stimulation of estrone. The cervix atrophies and blushes with the vaginal vault. Cervical secretion becomes scarce, thick and then disappears. The vaginal epithelium atrophies with loss of roughness. The vaginal smear shows atrophic changes. The vagina contracts with the superficiality of the fornices. The vulva gradually atrophies with narrowing of the introite: the pelvic cell tissue gradually becomes loose.
Secondary sexual characteristics. The breasts show a gradual atrophy of the glandular tissue that results in flaccid. These become pendular due to the deposition of fat around. Pubic and axillary hair becomes scarce.
Physical. Body weight decreases after 65 years. There is decrease in the cellular mass of the organs. Skin wrinkles become less elastic and hair appears on the face. Subcutaneous fat deposition. It occurs in the hip and thighs. The height decreases posttraenopausally after 65 years. Kyphosis can develop due to spinal osteoporosis.
Metabolic. Osteoporosis occurs as a result of estrogen deprivation. The reduction in trabecular bone (collagen matrix) (osteoblasts) and calcium leads to estrogen-deprived osteoporosis. Premenopausal, the woman is protected against iscarcinogenic heart disease due to high HDL and low LDL cholesterol. The latter increases after menopause, so the incidence of iscaernic heart disease also increases. Natural or oophorectomy premature menopause has an increased risk of cardiovascular disease (stroke and stroke) and osteoporosis.
Digestive. Hypochlorhydria develops. The motor activity of the entire alimentary tract decreases, resulting in dyspepsia and constipation in postmenopausal women. Bladder and urethral epithelia atrophy.
Psychosexual Emotional disorders are common. In menopause, the sex drive can increase. After 60 years, the sex drive decreases as an aging process.
Endocrinal There is gonadal failure in menopause. The level of estradiol in plasma falls, the estrone is still normal, however, the ovarian stroma produces andostenedione. Extraglandular conversion of androstenedione to estrone occurs in fatty tissue. After menopause, the adrenal cortex becomes the source of estrone derived from androstenedione. Estrone becomes the predominant estrogen after menopause. The daily formation of postmenopausal estrone has been estimated at 15 100 gg / day (Mac Donald et al, 1973) and the serum level at 30 70 pg / ml. Progesterone secretion ceases in the ovary due to the failure of ovulation. The total urinary estrogen level drops to approximately 6 Pg1 24 hours in the postmenopausal period. Androstenedione level mainly of the adrenal cortex, little. of the ovary reaches half of what was seen before menopause. The testosterone level does not decrease appreciably because the postmenopausal ovary secretes more testosterone.
Pituitary gonadotropins. FHS and LH are secreted in increasing quantity due to the absence of negative feedback control by ovarian steroids. The ovulatory surge of LH disappears, the mean serum baseline menopausal gonadotropin levels are in the range of 50 150 rn LU / ml FSH and 50 100 mIU / ml LH. The FSH level is 15 times higher than the premenopausal level in 3-5 years after menopause, while the level of LH increases 3 times. The level of prolactin falls.
Synchronization. The climacteric process can begin gradually 2 3 years before menopause, but it can continue 2 5 years later. The age at which menopause occurs varies widely from 40 to 55 years with an average age of approximately 47 years. Genetic composition, race and climate influence the age of menopause. Women in the tropics have an earlier menopause than those in colder weather. Some believe that the earlier menarche begins, the later it would be menopause, while the late arrival of menarche is associated with early menopause. Early or late menopause is considered when menopause occurs before age 35 or after age 55, respectively. Early menopause may be due to ovarian failure, oophorectomy or ovarian irradiation.
Late menopause is usually due to some pelvic pathology such as uterine fibroid or in association with the disease, for example, diabetes mellitus.
Clinical characteristics of menopause and the climacteric
Menstrual symptoms This occurs in the form of (a) poor progressive menstrual loss followed by cessation of menstruation, (b) menstruation at prolonged intervals that eventually cease, (c) sudden cessation of menstruation. Before menopause, menstrual cycles become anovulatory. Any excessive menstrual loss or irregular bleeding is not menopausal as is commonly believed by the general public, but is due to some pelvic pathology.
Other symptoms Most women remain asymptomatic. They adapt very well to the physiological changes of menopause. Some may have mild symptoms of weight gain, joint pain, increased sexual desire followed by gradual decrease.
Signals The following signs appear gradually in a normal woman in the menopausal period and subsequently.
- General signals. Weight gain, fat deposit in the hip, buttocks, around the breasts. The breasts are examined.
- Genital signs.
Vulva. Progressive atrophy with sparse hair with narrowing of the vaginal introite.
Vagina. This becomes narrow with ‘carp’ of vaginal vault, thinning of the mucous membrane and 18ss of rugae.
Cervix. Portio vaginalis atrophies and reddens with a vaginal vault.
Uterus. The body feels small and hard.
Annexes The ovaries become impalpable.
Diagnosis. This can be done from clinical features aided by an atrophic vaginal smear and an elevated serum FSH level of 50 mIU / ml and above. The elevated level of plasma LH is less useful. The level of estrogen in urine or serum shows a similar value to the follicular phase and, therefore, less reliable for diagnosis.
Differential diagnosis. The interruption of menstruation due to menopause can be simulated by pseudocisesis or pregnancy.
Treatment. Psychotherapy. The explanations of the condition and the guarantees must be given to the woman who goes through the climacteric when she seeks advice to stop menstruating. The improvement of health should be guaranteed through adequate dietary adjustment, rest and exercise and regular bowel movement. For sleep disorders, diazepam (Valium) 5 mg. o Lorazepam 1 or 2 mg. It is taken orally at bedtime.
Menopause or climacteric syndrome
Menopausal syndrome refers to the group of symptoms that some women experience during the climacteric. Hot flashes (symptom of vasomotor instability) that last a year at 80% are characteristic of menopausal syndrome. It decreases by itself in 3 4 years. The cause of hot flashes is unclear, but it follows estrogen withdrawal in women with poor vascular control. The increase in hypothalamic endorphin is implicated. It is experienced by 25% of women with a psychological history, particularly after oophorectomy or ovarian irradiation at an earlier age.
The discharge depends on the rate of estrogen loss and the formation of extragonadal estrone. The body gradually adjusts to the natural decline of estrogen and hot flashes gradually disappear.
Symptoms These appear as follows: vasomotor and other symptoms usually follow, but even precede the cessation of menstruation.
- Menstrual. Menstruation stops as described in menopause. A proportion of premenopausal women have emotional symptoms, loss of libido and dry vagina during intercourse, hot flashes and sweating complain about poor and late menstruation.
- Vasomotor. These commonly experience ‘hot flashes’ (sensation of heat) due to cutaneous vasodilation, women in the face and neck spread throughout the body; This feeling of heat can be followed by sweating. They can come once a day but sometimes every hour; They come especially at night. These are characteristic manifestations of menopausal syndrome.
- Emotional This is manifested by headache, irritability, insomnia, vertigo, fatigue, depression, palpitations. There may be sensations of ‘pins and needles’ in the sole and palm. Disturbed sleep may be due to hot flashes and sweats.
- Sexual These are decreased libido and dyspareunia due to atrophic vaginitis and lack of vaginal lubrication during sexual intercourse.
- Musculoskeletal. These appear as back pain, joint pain due to laxity of the ligaments and muscles.
Signals These are the same as described in menopause.
Diagnosis. This has already been described in menopause.
Differential diagnosis. The patient can confuse pseudocystosis of spurious pregnancy with menopausal syndrome. In the first, amenorrhea, enlarged breasts and abdomen due to fat deposition as in pregnancy; There is also the false sensation of fetal movements due to flatulent dyspepsia. The patient must be sure that her symptoms are menopausal. In all these cases, pregnancy can also occur and should be carefully excluded through an exhaustive examination, an immunological urinary pregnancy test and a pelvic ultrasound.
Definition. Menopause that reaches a patient under 35 is called premature menopause. Why. The small stock of ovarian follicles is depleted. Clinical features, symptoms, secondary amenorrhea for more than 6 months. In some hot flashes, mood instability, sleep disorders, loss of libido (menopausal syndrome). Hair styling Signs. Atrophic vaginal epithelism, normal or small uterus. Investigations High serum FSH above 50 mUI / ml; An ovarian biopsy that does not show ovarian follicles is not performed. Treatment guarantee, diazepam to sleep badly. Estrogens are administered for menopausal syndrome. Menstruation can not lead to hormonal therapy.
Climacterico Masculino. About 10 percent of men experience climacteric symptoms at a later age than women due to androgen deprivation. The remaining 90 percent gradually adapt without symptoms.