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MENOPAUSE

MENOPAUSE. A natural, normal physiological change. Permanent cessation of menstruation. Not a disease or a medical problem. From reproductive life to non-reproductive life. Complex mix of areas: physical social psychological cultural spiritual. MENOPAUSE.

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MENOPAUSE

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  1. MENOPAUSE • A natural, normal physiological change. • Permanent cessation of menstruation. • Not a disease or a medical problem. • From reproductive life to non-reproductive life. • Complex mix of areas: • physical • social • psychological • cultural • spiritual

  2. MENOPAUSE • Long transition period leading to menopause: • climacteric, a.k.a. perimenopause • Age: • 35-60 • Climacteric: • ovaries less and less responsive to FSH • decline of estrogen and progesterone production

  3. MENOPAUSE • Climacteric (Cont’d): • ovulation skips: anovulatory cycles • periods less blood, shorter, skips, irregular • less testosterone • Still capable of reproduction • Menopause: • 12 continuous months without a period

  4. MENOPAUSE • Some estrogen and progesterone produced by: • adrenal glands • skin • muscle • brain • pineal gland • hair follicles • These hormones stored in fatty tissue

  5. MENOPAUSE • Universal signs of menopause: • cessation of menses • cessation of ovulation • decreased hormonal output • vaginal dryness • skin changes

  6. MENOPAUSE • Non-universal changes • hot flashes • tachycardia • headaches • memory lapses • fatigue • irritability • depression • Cultural differences

  7. MENOPAUSE • “Associated” medical conditions: • Osteoporosis (brittle bones) • Heart Disease • Osteoporosis: • Bones lack calcium, become weak, easily broken. North American diet relatively high in calcium. No correlation between amount of Ca++ in diet and incidence of osteoporosis (Asia).

  8. MENOPAUSE • Osteoporosis (Cont’d): • But – excess of protein in the diet results in Ca++ loss during metabolism. • Prevention: • exercise (aerobic and weights) • good diet, phytoestrogens • no smoking

  9. MENOPAUSE • Osteoporosis (Cont’d): • Men also get osteoporosis after about age 50 yet they do not suffer “estrogen deprivation”. • Women 1 in 4, men 1 in 8 • Muscle mass helps to prevent osteoporosis. Men usually have more muscle due to testosterone. • Baseline bone density test, repeat 5 years

  10. MENOPAUSE • Heart Disease: • Uncommon until 20th century • Longevity: • women’s life expectancy from 48 to 84. • Genetics and Lifestyle

  11. MENOPAUSE • Heart Disease (Cont’d) • Factors that increase incidence: • excess weight • consumption of ‘bad’ fats • sedentary life • smoking (first and second hand) • contraceptive pill • These are cumulative: greater effects with increased age. • Same preventative measures as for osteoporosis. Baseline for blood pressure and stress test.

  12. MENOPAUSE • Hormone Replacement Therapy (HRT): • Completely discredited today. HRT can cause: • reproductive cancers • heart disease • dementias • asthma • hearing loss • memory loss • and other health problems

  13. MENOPAUSE • Exercise: • as essential as breathing and eating • Benefits: • healthy weight • energy • mental acuity • antidepressant • strengthens immune system, lower incidence of all morbidity • stress buster

  14. MENOPAUSE • Exercise (Cont’d): • Benefits: • improves sex life • sweating important for cleaning toxins, skin • cardiovascular health: lower incidence of heart attacks and strokes • lower incidence of osteoporosis • low incidence of menopausal symptoms • helps with balance in old age

  15. MENOPAUSE • Exercise (Cont’d): • Should be a life-long habit. Lifestyle coadjuvants: • no smoking • balanced diet • good sleep habits

  16. MENOPAUSE • Exercise (Cont’d): • Barriers: • urbanization • TV • computers • desk jobs • multiple demands on women, double shift • affluence, mechanization (cars, shopping, etc.) • pharmaceutical culture • no tangible cultural rewards • not a serious part of school curriculum • not part of traditional female role

  17. MENOPAUSE • Psycho-Socio-Cultural Aspects of Menopause: • In Western cultures menopause is associated with decline and with loss of status for women. • Aging seen as loss of value.

  18. MENOPAUSE • Fear of Aging Associated With Menopause Causes: • negative expectations • negative thoughts and emotions • defeatist behaviours • So menopausal symptoms are magnified.

  19. MENOPAUSE • Cultural Influences: • “Sex for procreation only” • “Sex is for the young” • “Old people who have sex are dirty and disgusting”

  20. MENOPAUSE • Culture and Menopause: • Androcentric Image of Women: • sexy • young • fertile • Post-Menopausal women: • dry • withered • unattractive • Advertising • Medicine

  21. MENOPAUSE • Importance of youth reinforced by: • cosmetic industry • fashion industry • cosmetic surgery fad • medical-pharmaceutical industry • Western illness model is very profitable.

  22. MENOPAUSE • Some Cultures Associate Menopause with: • power • wisdom • high social status • leadership roles • respect • In these cultures women have few complaints about menopause

  23. MENOPAUSE • Menopause and Sex: • 50% report more enjoyment: • no fear of pregnancy • partners slower • more self-assured • Use of artificial lubricants • Vagina: • use it or lose it (atrophy)

  24. ANDROPAUSE • Male Climacteric (Male Menopause or Andropause) • 40-55 • Some real physical changes – less obvious than women • Confounded with normal aging changes: • less energy • slower RT (reaction time) • less vigorous responses

  25. ANDROPAUSE • And With Disease effects: • diabetes • circulatory • depression • surgery • medications • hypercholesterolemia • kidney problems • prostate problems

  26. ANDROPAUSE • Testosterone Drops: • testosterone maintains muscle, stimulates bone health, so less testosterone leads to reduced muscle mass and weaker bones. • Sperm Count: • also affected (drops) due to testosterone drop.

  27. ANDROPAUSE • Sexual Performance Declines: • increased episodes of impotence • genitals shrink, prostate enlarges • more time to reach arousal • erections less hard • ejaculations less forceful, less quantity • increased refractory period

  28. ANDROPAUSE • Estrogen Drops: • estrogen helps cardiac health, prevents atherosclerosis, counteracts LDL cholesterol, so less estrogen increases probability of atherosclerosis (arterial plaque) and of “bad” cholesterol. • More and more men on HRT. • Sildenafil (Viagra) • Cialis • Levitra

  29. ANDROPAUSE • HRT for Men: • Testosterone • Can cause • prostate cancer • prostate enlargement • blood clots • lower HDL (the ‘good’ cholesterol) • heart disease • Same prevention: • lifestyle

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