Menopause
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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
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


Menopause1
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


Menopause2
MENOPAUSE

  • Climacteric (Cont’d):

    • ovulation skips

    • periods less blood, shorter, skips, irregular

    • less testosterone

  • Still capable of reproduction

  • Menopause:

    • 12 continues months without a period


Menopause3
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  • Some estrogen and progesterone produced by:

    • adrenal glands

    • skin

    • muscle

    • brain

    • pineal gland

    • hair follicles

  • These hormones stored in fatty tissue


Menopause4
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  • Universal signs of menopause:

    • cessation of menses

    • cessation of ovulation

    • decreased hormonal output

    • vaginal dryness

    • skin changes


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  • Non-universal changes

    • hot flashes

    • tachycardia

    • headaches

    • memory lapses

    • fatigue

    • irritability

    • depression

  • Cultural differences


Menopause6
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  • “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).


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  • 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


Menopause8
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  • 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.


Menopause9
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  • Baseline bone density test, repeat 5 years.

  • Heart Disease:

    • Uncommon until 20th century

    • Longevity:

      • women’s life expectancy from 48 to 84.


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  • Genetics and Lifestyle:

    • 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.


Menopause11
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  • Hormone Replacement Therapy (HRT):

    • Completely discredited to day. HRT can cause:

      • reproductive cancers

      • heart disease

      • dementias

      • asthma

      • hearing loss

      • memory loss


Menopause12
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


Menopause13
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  • 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


Menopause14
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  • Exercise (Cont’d):

    • Should be a life-long habit. Lifestyle coadjuvants:

      • no smoking

      • balanced diet

      • good sleep habits

    • Barriers:

      • urbanization

      • TV

      • computers


Menopause15
MENOPAUSE

  • Exercise (Cont’d):

    • Barriers:

      • urbanization

      • TV

      • computers

      • desk jobs

      • multiple demands on women, double shift

      • affluence, mechanization (cars, shopping, etc.)

      • pharmaceutical culture

      • no tangilbe cultural rewards

      • not a serious part of school curriculum

      • not part of traditional female role


Menopause16
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  • 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.


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  • Fear of Aging Associated With Menopause Causes:

    • negative expectations

    • negative thoughts and emotions

    • defeatist behaviours

      • So menopausal symptoms are magnified.


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  • Importance of youth reinforced by:

    • cosmetic industry

    • fashion industry

    • cosmetic surgery fad

    • medical-pharmaceutical industry

      • Western illness model is very profitable.


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  • Some Cultures Associate Menopause with:

    • power

    • wisdom

    • high social status

    • leadership roles

    • respect

  • In these cultures women have few complaints about menopause


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  • 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)


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  • Cultural Influences:

    • “Sex for procreation only”

    • “Sex is for the young”

    • “Old people who have sex are dirty and disgusting”


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  • Cultural and Menopause:

    • Androcentric Image of Women:

      • sexy

      • young

      • fertile

    • Post-Menopausal women:

      • dry

      • withered

      • unattractive

  • Advertising

  • Medicine


Menopause23
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  • 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


Menopause24
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  • And With Disease effects:

    • diabetes

    • circulatory

    • depression

    • surgery

    • medications

    • hypercholesterolemia

    • kidney problems

    • prostate problems


Menopause25
MENOPAUSE

  • 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.


Menopause26
MENOPAUSE

  • 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


Menopause27
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  • 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


Menopause28
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  • 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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