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:
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physical
social
psychological
cultural
spiritual
MENOPAUSE
 Long
transition period leading to
menopause:
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climacteric, a.k.a. perimenopause
 Age:

35-60
 Climacteric:
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ovaries less and less responsive to FSH
decline of estrogen and progesterone
production
MENOPAUSE
 Climacteric
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(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
MENOPAUSE
 Some
estrogen and progesterone
produced by:
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adrenal glands
skin
muscle
brain
pineal gland
hair follicles
 These
hormones stored in fatty tissue
MENOPAUSE
 Universal
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signs of menopause:
cessation of menses
cessation of ovulation
decreased hormonal output
vaginal dryness
skin changes
MENOPAUSE
 Non-universal
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changes
hot flashes
tachycardia
headaches
memory lapses
fatigue
irritability
depression
 Cultural
differences
MENOPAUSE
 “Associated”
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
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).
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
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
MENOPAUSE
 Heart


Disease:
Uncommon until 20th century
Longevity:
• women’s life expectancy from 48 to 84.

Genetics and Lifestyle
MENOPAUSE
Heart Disease (Cont’d)
 Factors that increase incidence:
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•
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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.
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
MENOPAUSE
 Exercise:
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as essential as breathing and eating
Benefits:
•
•
•
•
•
healthy weight
energy
mental acuity
antidepressant
strengthens immune system, lower incidence of all
morbidity
• stress buster
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
MENOPAUSE
 Exercise

(Cont’d):
Should be a life-long habit. Lifestyle
coadjuvants:
• no smoking
• balanced diet
• good sleep habits
MENOPAUSE
 Exercise

(Cont’d):
Barriers:
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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
MENOPAUSE
 Psycho-Socio-Cultural Aspects
of
Menopause:
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
In Western cultures menopause is associated
with decline and with loss of status for
women.
Aging seen as loss of value.
MENOPAUSE
 Fear
of Aging Associated With Menopause
Causes:
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negative expectations
negative thoughts and emotions
defeatist behaviours
• So menopausal symptoms are magnified.
MENOPAUSE
 Cultural
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Influences:
“Sex for procreation only”
“Sex is for the young”
“Old people who have sex are dirty and
disgusting”
MENOPAUSE
 Culture

and Menopause:
Androcentric Image of Women:
• sexy
• young
• fertile

Post-Menopausal women:
• dry
• withered
• unattractive
 Advertising
 Medicine
MENOPAUSE
 Importance
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of youth reinforced by:
cosmetic industry
fashion industry
cosmetic surgery fad
medical-pharmaceutical industry
• Western illness model is very profitable.
MENOPAUSE
 Some
Cultures Associate Menopause
with:
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 In
power
wisdom
high social status
leadership roles
respect
these cultures women have few
complaints about menopause
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)
ANDROPAUSE
 Male
Climacteric (Male Menopause or
Andropause)

40-55
real physical changes – less
obvious than women
 Confounded with normal aging changes:
 Some
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less energy
slower RT (reaction time)
less vigorous responses
ANDROPAUSE
 And
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With Disease effects:
diabetes
circulatory
depression
surgery
medications
hypercholesterolemia
kidney problems
prostate problems
ANDROPAUSE
 Testosterone

testosterone maintains muscle, stimulates
bone health, so less testosterone leads to
reduced muscle mass and weaker bones.
 Sperm

Drops:
Count:
also affected (drops) due to testosterone drop.
ANDROPAUSE
 Sexual
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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
ANDROPAUSE
 Estrogen

estrogen helps cardiac health, prevents
atherosclerosis, counteracts LDL cholesterol,
so less estrogen increases probability of
atherosclerosis (arterial plaque) and of “bad”
cholesterol.
 More



Drops:
and more men on HRT.
Sildenafil (Viagra)
Cialis
Levitra
ANDROPAUSE
 HRT

for Men:
Testosterone
• Can cause
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prostate cancer
prostate enlargement
blood clots
lower HDL (the ‘good’ cholesterol)
heart disease
Same prevention:
• lifestyle