“CHANGING CARE WITH CHANGING BODIES AND CHANGING NEEDS ! - A health awareness module for women Dr.Maninder Ahuja Geriatric Gynaecology Committee of FOGSI Chairperson public Awareness committee IMS 06/15/22 Dr.Maninder Ahuja,dr.Duru shah
Dec 21, 2015
“CHANGING CARE WITH CHANGING BODIES AND
CHANGING NEEDS !
“CHANGING CARE WITH CHANGING BODIES AND
CHANGING NEEDS !
- A health awareness module for women
- A health awareness module for women
Dr.Maninder Ahuja Geriatric Gynaecology Committee of FOGSIChairperson public Awareness committee IMS
Dr.Maninder Ahuja Geriatric Gynaecology Committee of FOGSIChairperson public Awareness committee IMS
04/19/23Dr.Maninder Ahuja,dr.Duru shah
“The woman is an axle around whom not only the family or society but the whole universe revolves”.
Her health is of utmost
importance in all stages of
her life….. more so in menopause
“The woman is an axle around whom not only the family or society but the whole universe revolves”.
Her health is of utmost
importance in all stages of
her life….. more so in menopause
A Woman is the pivot of the Universe!
A Woman is the pivot of the Universe!
04/19/23Dr.Maninder Ahuja,dr.Duru shah
““Fit at 40”Fit at 40”““Fit at 40”Fit at 40”
““Independent at Independent at 80”80”
““Independent at Independent at 80”80”
““Strong at 60”Strong at 60” ““Strong at 60”Strong at 60”
We have changedWe have changed
toto
toto
fromfrom
04/19/23Dr.Maninder Ahuja,dr.Duru shah3
Our AimOur Aim• offer a better quality of Life• Prevent disabilities• Functional independence• Prevent cancers• Treat Medical & other menopausal problems
• offer a better quality of Life• Prevent disabilities• Functional independence• Prevent cancers• Treat Medical & other menopausal problems
04/19/23Dr.Maninder Ahuja,dr.Duru shah4
Why is Menopause so significant?Why is Menopause so significant?Because the no. of years lived after menopause is increasing Because the no. of years lived after menopause is increasing
The life span of a woman has increased from 23 years in the Roman era to 65 years in India and 80 years in developed countries
1/3rd of a woman’s life is spent after Menopause.
The life span of a woman has increased from 23 years in the Roman era to 65 years in India and 80 years in developed countries
1/3rd of a woman’s life is spent after Menopause.
Year
1850 1900 1950 20000
20
40
80
60Age
(Year)
Source: US Dept of Health and Human Services; 1999;47(28).04/19/23Dr.Maninder Ahuja,dr.Duru shah5
Comparison of post menopausal women worldwide over the yearsComparison of post menopausal women worldwide over the years
Source : World Bank ReportSource : World Bank Report
1990 By 2030
Worldwide population
470 million 1.2 billion
Developed countries
40% 24%
Developing countries
60% 76%
04/19/23Dr.Maninder Ahuja,dr.Duru shah6
Menopause defined Menopause defined
•There should be absence of menses for 12 months
•Average age 46-51 years
•Can be surgically induced
•Premature menopause before 40 years of age
•There should be absence of menses for 12 months
•Average age 46-51 years
•Can be surgically induced
•Premature menopause before 40 years of age 04/19/23Dr.Maninder Ahuja,dr.Duru shah
7
Menopause – its implications
Menopause – its implications•Ovaries do not
produce eggs!
•Estrogen levels fall
•No periods•No pregnancy
04/19/23Dr.Maninder Ahuja,dr.Duru shah8
There are always two sides of a coin
There are always two sides of a coin
04/19/23Dr.Maninder Ahuja,dr.Duru shah9
Women’s perception of menopause
Women’s perception of menopauseVaries from person to personVaries from person to person
Positive • Relief from monthly period• No contraception No contraception required required • No pregnancy No pregnancy worries worries• Advantages of Advantages of senior citizen in senior citizen in society society
Positive • Relief from monthly period• No contraception No contraception required required • No pregnancy No pregnancy worries worries• Advantages of Advantages of senior citizen in senior citizen in society society
Negative • Fear of old age • Isolation and loneliness• Disturbance by symptoms of menopause & changing body image
Negative • Fear of old age • Isolation and loneliness• Disturbance by symptoms of menopause & changing body image
04/19/23Dr.Maninder Ahuja,dr.Duru shah10
Why do we reach menopause?
Why do we reach menopause?• At puberty, the ovaries At puberty, the ovaries
produce two female produce two female hormones, hormones, estrogen and estrogen and progesterone progesterone and a maleand a male hormone, hormone, androgen.androgen.• Gradually, as a woman Gradually, as a woman approaches her midlife approaches her midlife years, years, the production of these the production of these hormones slows down and hormones slows down and
eventually stops eventually stops altogetheraltogether at menopause. at menopause.
Contd..
04/19/23Dr.Maninder Ahuja,dr.Duru shah11
HormonesHormones
ESTROGENSESTROGENS
PROGESTRONESPROGESTRONES
ANDROGENSANDROGENS
04/19/23Dr.Maninder Ahuja,dr.Duru shah12
Role of EstrogenRole of Estrogen
Estrogen is the “female” hormone responsible for the change from girlhood to womanhood
Estrogen is the “female” hormone responsible for the change from girlhood to womanhood
Contd..Contd..
04/19/23Dr.Maninder Ahuja,dr.Duru shah 13
Role of ProgesteroneRole of Progesterone
Progesterone is the hormone which helps to support a pregnancy if it occurs
Progesterone is the hormone which helps to support a pregnancy if it occurs
Contd..Contd..Contd..Contd..
04/19/23Dr.Maninder Ahuja,dr.Duru shah14
Role of AndrogensRole of Androgens
Androgen is the hormone responsible for the growth of axillary and pubic hair, mood and desire for sex
Androgen is the hormone responsible for the growth of axillary and pubic hair, mood and desire for sex
Contd..Contd..
04/19/23Dr.Maninder Ahuja,dr.Duru shah15
The female hormone -estrogen
The female hormone -estrogen It helps
• To maintain the body shape of a woman
• To regulate monthly periods• To keep the tissues of skin, blood
vessels & reproductive tract healthy
• To regulate mood and behavior patterns
• To promote sex drive• To keep cholesterol levels lower• To preserve bones
It helps • To maintain the body shape of a
woman• To regulate monthly periods• To keep the tissues of skin, blood
vessels & reproductive tract healthy
• To regulate mood and behavior patterns
• To promote sex drive• To keep cholesterol levels lower• To preserve bones 04/19/23Dr.Maninder Ahuja,dr.Duru shah
16
Menopause comes in phases!
Menopause comes in phases!
Premenopause-regular cycles, fertility maintained Premenopause-regular cycles, fertility maintained
Peri menopause-irregular cycles, may have symptoms fertility suboptimal
Peri menopause-irregular cycles, may have symptoms fertility suboptimal
MenopauseMenopause – No periods for 12 months, may have No periods for 12 months, may have symptoms – no fertility symptoms – no fertility
MenopauseMenopause – No periods for 12 months, may have No periods for 12 months, may have symptoms – no fertility symptoms – no fertility
04/19/23Dr.Maninder Ahuja,dr.Duru shah
Initially 7 symptoms were associated with menopauseInitially 7 symptoms were
associated with menopause
04/19/23Dr.Maninder Ahuja,dr.Duru shah18
But now this mid life crisis has
about 35 symptoms!
But now this mid life crisis has
about 35 symptoms!VASOMOTOR SYMPTOMS
• Hot flushes
• Mood changes
• Depression
• Sleep disturbances
• Fatigue
VASOMOTOR SYMPTOMS
• Hot flushes
• Mood changes
• Depression
• Sleep disturbances
• Fatigue Contd..Contd..04/19/23Dr.Maninder Ahuja,dr.Duru shah
19
Symptoms contd..Symptoms contd..
UROGENITAL SYMPTOMS
• Dryness of vagina
• Dysuria
• Urinary Leak
• Urinary Frequency
• Sexuality problems
UROGENITAL SYMPTOMS
• Dryness of vagina
• Dysuria
• Urinary Leak
• Urinary Frequency
• Sexuality problems Contd..Contd..
04/19/23Dr.Maninder Ahuja,dr.Duru shah20
MUSCULOSKELETAL
• Sarcopenia / weakness of muscles
• Joint aches and pains
• Osteoarthritis
• Osteoporosis
MUSCULOSKELETAL
• Sarcopenia / weakness of muscles
• Joint aches and pains
• Osteoarthritis
• OsteoporosisContd..Contd..
Symptoms contd..Symptoms contd..
04/19/23Dr.Maninder Ahuja,dr.Duru shah21
• Menstrual irregularities
• Unintended pregnancy
• Palpitation
• Muscle and joint pain
• Low backache
• Dryness of skin
• Hair loss, nail problems
• Eye problems
• Gum and teeth problems
• Menstrual irregularities
• Unintended pregnancy
• Palpitation
• Muscle and joint pain
• Low backache
• Dryness of skin
• Hair loss, nail problems
• Eye problems
• Gum and teeth problems
Symptoms contd..Symptoms contd..
04/19/23Dr.Maninder Ahuja,dr.Duru shah22
Long term problemsLong term problems
Forgetfulness,Alzheimer’sOsteoporosis Heart disease
OTHERSOTHERS
ArthritisArthritis Diabet
esDiabetes
HypertensHypertensionion
Problems of Hearing, visionProblems of Hearing, vision Contd..04/19/23Dr.Maninder Ahuja,dr.Duru shah
23
Long term problemsLong term problems
METABOLIC
• Increased risk of CHD
• Hypertension
• More chances of diabetes
• Alzheimer / loss of memory
METABOLIC
• Increased risk of CHD
• Hypertension
• More chances of diabetes
• Alzheimer / loss of memory
04/19/23Dr.Maninder Ahuja,dr.Duru shah24
These cancers are not because of menopause but are there in this age group
Cancer cervix Cancer breast Cancer ovaries Cancer endometrium
04/19/23Dr.Maninder Ahuja,dr.Duru shah 25
Some Myths and FactsSome Myths and Facts
Myth Myth - - Menopause is natural Menopause is natural with no clinical with no clinical consequencesconsequences
Myth Myth - - Menopause is natural Menopause is natural with no clinical with no clinical consequencesconsequences
Fact – It does have clinical consequences
Fact – It does have clinical consequences
Contd..Contd..
04/19/23Dr.Maninder Ahuja,dr.Duru shah26
Some myths and factsSome myths and facts
Myth - No treatment is necessary
Myth - No treatment is necessary
Fact - Treatment is necessary for a better quality of life
Fact - Treatment is necessary for a better quality of life
Contd..Contd..
04/19/23Dr.Maninder Ahuja,dr.Duru shah27
Some myths and factsSome myths and facts
Myth - Menopausal women should not be offered HRT
Myth - Menopausal women should not be offered HRT Fact -
HRT is definitely recommended as an option for symptomatic menopausal women
Fact - HRT is definitely recommended as an option for symptomatic menopausal women Contd..04/19/23Dr.Maninder Ahuja,dr.Duru shah
28
Some myths and factsSome myths and facts
Myth – Menopause has no effect on mental health
Myth – Menopause has no effect on mental health Fact -
Menopause and low estrogen levels are associated with depression
Fact - Menopause and low estrogen levels are associated with depression
04/19/23Dr.Maninder Ahuja,dr.Duru shah29
What are hot flushes?What are hot flushes?
• Feeling of “heat” in the Feeling of “heat” in the face & upper body face & upper body followed by cold sweats followed by cold sweats• Can occur any time in theCan occur any time in the day or night day or night• Can disturb sleepCan disturb sleep• Can cause feeling of Can cause feeling of fatigue fatigue• Can be accompanied by Can be accompanied by irritability, mood irritability, mood swings, depression swings, depression
• Feeling of “heat” in the Feeling of “heat” in the face & upper body face & upper body followed by cold sweats followed by cold sweats• Can occur any time in theCan occur any time in the day or night day or night• Can disturb sleepCan disturb sleep• Can cause feeling of Can cause feeling of fatigue fatigue• Can be accompanied by Can be accompanied by irritability, mood irritability, mood swings, depression swings, depression
04/19/23Dr.Maninder Ahuja,dr.Duru shah30
What can be done?What can be done?
• Wear loose clothes Wear loose clothes preferably inlayers preferably inlayers• Cool down the Cool down the body temperature body temperature with moist wipes with moist wipes• Try to relaxTry to relax• YogaYoga• Meditation Meditation
• Wear loose clothes Wear loose clothes preferably inlayers preferably inlayers• Cool down the Cool down the body temperature body temperature with moist wipes with moist wipes• Try to relaxTry to relax• YogaYoga• Meditation Meditation
04/19/23Dr.Maninder Ahuja,dr.Duru shah31
Other methods to prevent hot flushes
Other methods to prevent hot flushes
The following are suggested to reduce an attack• Avoid spicy food• Avoid coffee, tea, alcohol• Eat lentils, Soya products,• Wear loose cotton clothes• Avoid hot water bath just before sleeping• Alternative medicines like isoflavones• Medical treatment options like Hormone therapy
The following are suggested to reduce an attack• Avoid spicy food• Avoid coffee, tea, alcohol• Eat lentils, Soya products,• Wear loose cotton clothes• Avoid hot water bath just before sleeping• Alternative medicines like isoflavones• Medical treatment options like Hormone therapy
04/19/23Dr.Maninder Ahuja,dr.Duru shah32
Vaginal symptomsVaginal symptoms
• Vaginal drynessVaginal dryness
• ItchingItching
• IrritationIrritation
• Pain on urinationPain on urination
• Discomfort Discomfort associated associated with sexual activity with sexual activity
• Bleeding during Bleeding during intercourse intercourse
• Vaginal drynessVaginal dryness
• ItchingItching
• IrritationIrritation
• Pain on urinationPain on urination
• Discomfort Discomfort associated associated with sexual activity with sexual activity
• Bleeding during Bleeding during intercourse intercourse 04/19/23Dr.Maninder Ahuja,dr.Duru shah
33
Urinary problems in menopause
Urinary problems in menopause• Leak of urine on
coughing, sneezing, bending - stress urinary incontinence – a social problem• Unable to hold urine – urge incontinence• Frequency in urination• Retention with overflow
• Leak of urine on coughing, sneezing, bending - stress urinary incontinence – a social problem• Unable to hold urine – urge incontinence• Frequency in urination• Retention with overflow 04/19/23Dr.Maninder Ahuja,dr.Duru shah
35
Management of urogenital symptoms
Management of urogenital symptoms
• Water based lubricants/no baby creams or hand lotions
• Local estrogen preparations• For urinary symptoms, bladder diary• Urine examination • Tests for incontinence• Kegels exercises• Surgery• Bladder training
• Water based lubricants/no baby creams or hand lotions
• Local estrogen preparations• For urinary symptoms, bladder diary• Urine examination • Tests for incontinence• Kegels exercises• Surgery• Bladder training
04/19/23Dr.Maninder Ahuja,dr.Duru shah36
04/19/23Dr.Maninder Ahuja,dr.Duru shah 37
• Minimally-invasive and simple surgical option to treat incontinence
• Completed in 30 minutes can be done under local anesthesia
• Patient returns home the same day• Minimal post-op pain • 96% success rate
– 85 % patients completely cured
– 11% patients experience significant improvement
• Minimally-invasive and simple surgical option to treat incontinence
• Completed in 30 minutes can be done under local anesthesia
• Patient returns home the same day• Minimal post-op pain • 96% success rate
– 85 % patients completely cured
– 11% patients experience significant improvement
Reduced sexual desireReduced sexual desire
DYSPAREUNIADYSPAREUNIADYSPAREUNIADYSPAREUNIA
Reduction ofReduction oforgasmic orgasmic capacitycapacity
Reduction ofReduction oforgasmic orgasmic capacitycapacity
ReduceReducesexualsexual
satisfactionsatisfaction
ReduceReducesexualsexual
satisfactionsatisfactionNegativelyNegativelyinfluencinginfluencing
sexualsexualmotivationmotivation
NegativelyNegativelyinfluencinginfluencing
sexualsexualmotivationmotivation
Decline inDecline inlibidolibido
Decrease Decrease frequencyfrequency
less less lubricationlubrication
Decrease Decrease frequencyfrequency
less less lubricationlubrication
04/19/23Dr.Maninder Ahuja,dr.Duru shah38
ManagementManagement
• Lubricating jelliesLubricating jellies
• Estrogen Vaginal Estrogen Vaginal
cream cream
• Mood elevatorsMood elevators
• Hormone Hormone replacement replacement therapy therapy
04/19/23Dr.Maninder Ahuja,dr.Duru shah39
Remaining in Part 2
Remaining in Part 2
04/19/23Dr.Maninder Ahuja,dr.Duru shah40