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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
MENOPAUSE
  • Some estrogen and progesterone produced by:
    • adrenal glands
    • skin
    • muscle
    • brain
    • pineal gland
    • hair follicles
  • These hormones stored in fatty tissue
menopause4
MENOPAUSE
  • Universal signs of menopause:
    • cessation of menses
    • cessation of ovulation
    • decreased hormonal output
    • vaginal dryness
    • skin changes
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MENOPAUSE
  • Non-universal changes
    • hot flashes
    • tachycardia
    • headaches
    • memory lapses
    • fatigue
    • irritability
    • depression
  • Cultural differences
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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).
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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
menopause8
MENOPAUSE
  • 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.
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MENOPAUSE
  • 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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MENOPAUSE
  • 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
MENOPAUSE
  • 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
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
menopause14
MENOPAUSE
  • 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
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.
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MENOPAUSE
  • Fear of Aging Associated With Menopause Causes:
    • negative expectations
    • negative thoughts and emotions
    • defeatist behaviours
      • So menopausal symptoms are magnified.
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MENOPAUSE
  • 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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MENOPAUSE
  • 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
  • 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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MENOPAUSE
  • Cultural Influences:
    • “Sex for procreation only”
    • “Sex is for the young”
    • “Old people who have sex are dirty and disgusting”
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MENOPAUSE
  • Cultural and Menopause:
    • Androcentric Image of Women:
      • sexy
      • young
      • fertile
    • Post-Menopausal women:
      • dry
      • withered
      • unattractive
  • Advertising
  • Medicine
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MENOPAUSE
  • 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
MENOPAUSE
  • 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
MENOPAUSE
  • 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
MENOPAUSE
  • 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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