- 1 Definition
- 2 Types of Menopause
- 3 Clinical Exam
- 4 Longterm Effects of Menopause
- 5 Management
- 5.1 Physical Therapy Intervention
- 5.2 Sexual Health
- 5.3 Exercise
- 5.4 Aquatic Therapy
- 5.5 Diet
- 6 Medical Interventions
- 7 Quick summary video
- 8 Resources
- 9 References
Natural menopause occurs when there is a complete, or near complete, ovarian follicular depletion of a female's ovaries. This results in the end of her menstrual cycle for 12 months, which is retrospectively determined. It occurs at a median age of 51.4 years and menopause before the age of 40 years old is considered abnormal. The months and years leading up to this are called peri-menopause.
Types of Menopause
Also known as spontaneous progressive decline of menstrual cycle due to decline of ovarian function, the average age is between 40-51 years of age.
Premature menopause: cessation of ovarian function before the age of 40.
- Artificial or surgical menopause; permanent cessation of ovarian of ovarian function due to surgical intervention, or medical treatment like chemotherapy, pelvic radiation therapy.
- Delayed menopause: cessation of ovarian function after the age of 51.
Symptoms of menopause and peri-menopause:
|Vaginal dryness and/or Sexual function||
|Joint pain/ arthritis Musculoskeletal pain/arthralgia||
Stages of Reproductive Aging Workshop (STRAW) staging system was developed from data from multiple longitudinal cohort studies. This system is considered the gold standard and includes criteria for the reproductive years, the menopausal transition, perimenopause, final menstrual period (FMP), and postmenopause based upon bleeding patterns, endocrine findings, and symptoms. The STRAW system is used mainly in research, however, it may be helpful in the clinical setting for patients and clinicians to assess fertility potential, contraceptive needs, and potential need for hormone therapy.
|Late reproductive years||May begin to notice changes in her menstrual cycle (ie. a shorter cycle)|
|Early menopausal transition||This is marked by increased variability in menstrual cycle length|
|Late menopausal transition||Marked by the occurrence of amenorrhea of 60 days or longer
Characterized by increased variability in cycle length, and extreme fluctuations in hormonal levels
|Early postmenopause period||Corresponds to the end of “perimenopause,” a term still in common usage that means the time around menopause|
|Late postmenopause period||Symptoms of vaginal dryness and urogenital atrophy become increasingly prevalent at this time|
Longterm Effects of Menopause
Physical Therapy Intervention
It is important as part of the healthcare team, we are aware of the menopausal process and the symptoms that can come along with this period. Many of the symptoms and health concerns discussed can have a negative impact on a women's health and overall quality of life. It can be beneficial to be able to identify patients who are dealing with these symptoms because we can aid through physiotherapy interventions or refer them to a physician.
Sexual health may be negatively impacted by some of the issues stated above. Simple, non‐hormonal interventions for sexual dysfunction are often overlooked. Several studies show that education on vaginal lubricants, moisturizers, and dilator use (as needed) can have a positive impact on sexual health. Pelvic health physiotherapists are well positioned to assist patients with this.
1.Weight bearing exercise:
Low impact weight bearing for example (walking, Tai Chi)
High impact weight bearing for example ( jogging, vibration platform)
2.resistance and strength exercise(weight lifting, swimming, cycling).
Exercises show to have a positive impact on;
Osteoporosis and Bone Density
Studies show that physiotherapists are able to assist in providing guidance around exercise in this population, but not all exercises have same osteogenic effect. Resistance exercise has stronger osteogenic effect, and for exercise to be effective it's mechanical load should exceed that of activities of daily life.
To obtain best result a combination of exercises that include (resistance and weight bearing exercises) is best choice to obtain the effect of both as resistance exercise affect on muscular loading, weight bearing has a mechanical loading effect on bone.
How exercise affect virtually on bone density still not clear but articles stated that exercise increase activity of osteoblast and inhibit osteoclast activity. Enhance bone strength as it increase cross sectional area due to mechanical loading in turn increase resistance of bone . A systematic review encompassing only randomized controlled trails, conducted by Howe et al. (2011) examined the effectiveness of exercise interventions in preventing bone loss and fractures in postmenopausal women, and they found that exercise was safe and effective way to prevent bone loss in this population.
Additionally, higher levels of participation in physical activity were independently associated with lower weight, waist circumference, and risk of substantial weight gain.
Regular, gradual aerobic exercise program improve cardio-respiratory endurance and decrease risk of (CVD),some articles agree that exercise increase level of HDL, decrease LDL and TAG, control hypertension that in turn improve cardiovascular.
Exercise therapy has an effect to relief symptoms in people with depression when compared to participants without clinical depression symptoms.
It show an increase in level of Brain -derived neurotrophic factor (BDNF) in depressed population but that didn't show improvement in depression symptoms and mechanism of how it affect depression not clear.
Regular exercise program show to increase metabolic rate and energy expenditure, promote loss of abdominal fats.
It provide water medium where stress on joints and muscles will be reduced.For women who would prefer to do exercise without feeling muscle soreness, fatigue after exercise and without applying stress on joint will be effective.
Benefits of Aquatic Therapy
Has bouncy effect that protect joint from stress of exercise that in turn relief joint pain as arthritis.
Improve general blood circulation and reduce swelling.
Provide strengthening exercise program for muscles without feeling soreness.
Improve cardio respiratory capacity and endurance.
Help with balance problems.
Physicians or a Registered Dietitian/Nutritionist can advise on diet,.Diet rich in fibers, fruits and vegetables . Vitamin D and calcium supplements may be with benefit.
Low caloric diet (calculated according to each individual's total calorie intake) with exercise show to be most effective for weight loss and loss of abdominal fats, In the study exercise program was 4 H/week , 60 minute /day exercise vary between resistance and endurance exercise,
Patients should discuss treatment options with their physicians. This may include menopause hormone replacement therapy to aid with the issues listed above. Hormonal replacement therapy (HRT) may be a support it can include estrogen with progestin for example;
- Resveratrol (phytoestrogen), has positive effect to improve cognitive decline and cerebrovascular function.
Talking with other women with menopause will be with benefit.
Quick summary video
About symptoms and how to control it.
American College of Obstetricians and Gynecologists: Menopause Resource Overview
For further information on managing menopause, please refer to this presentation by Dr. Kathryn Macaulay
How menopause affect on Lipid metabolism in menopausal women.
Physio Aqua menopause aquatic therapy can help
- The American College of Obstetricians and Gynecologists. Menopause: Resource Overview. Available from https://www.acog.org/Womens-Health/Menopause
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- Casilda-López J, Valenza MC, Cabrera-Martos I, Díaz-Pelegrina A, Moreno-Ramírez MP, Valenza-Demet G. Effects of a dance-based aquatic exercise program in obese postmenopausal women with knee osteoarthritis: a randomized controlled trial. Menopause. 2017 Jul 1;24(7):768-73.
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