Siraya K.

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Menopause (ภาวะว�ยหมดระด�)Menopause (ภาวะว�ยหมดระด�)

Siraya K.

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2523-2528 60.25 66.25 2528-2533 61.75 67.50 2533-2538 63.50 68.75 2538-2543 65.25 69.75 2543-2548 66.75 70.75 2548-2552 67.00 71.75 o°¤¼µ ° ªµÂ ¦¡¥µ¦¤ »¬¥r ε ´ µ ³ ¦¦¤ µ¦¡´ µµ¦� � � � � � � � � � � � � � � � � � � � � �Á«¦¬ ·Â³ ´ ¤� � � � �

ป� ป� 2554 2554 ชายไทย ชายไทย 69.5 69.5 ป�ป�ข�อม�ลจากสำ�าน กงานสำ�งเสำร�มสำ�ขภาพ

หญ งไทย หญ งไทย 76.3 76.3 ป�ป�

Age of menopause Average age of menopause

USA 50-52 years

Thai 47-50 years

- Sukwatana P. et al , Menopausal symptom among thai women in Bangkok. Maturitas 1991:13;217-28.- Chompootweep S. et al, The menopausal age and climacteric complaints in

Thai women in Bangkok. Maturitas 1993:17;63-71.- Jirochkul V. et al, A study of menopausal symptom in women attending the

menopause clinic at Siriraj hospital. Siriraj Hosp Gaz 1996:48;325-9.

Early menopause – smoking, surgery, chemotherapy, radiation

ป� 2554 49 ป�

Life expectancy and age of menopause

0102030405060708090

1850 1900 1950 2000

Burden of Menopause

• In Thailand, > 6 million women are menopause.• Around 10% of Thai Population

http://en.wikipedia.org/wiki/Demographics_of_Thailand

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Definitions

Changes in menopause

Management

อาย�

10

Premenopause

Climacteric

Perimenopause

Postmenopause

Menopause transition

20 40 50 60 70

menarchemenopause

ป�

Definition

Meno + Cessation (Month=เด�อน) (การส �นส�ด)

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Definitions

Changes in menopause

Management

ESTROGENESTROGEN

BRAIN- Vasomotor symptom

Cognitive and Alzheimer’s disease

Estrogen -> protecting CNS function

Mechanism

- Estrogen protects against neuronal cytotoxicity

induced by oxidation

- Estrogen increases synapes and neuronal growth,

especially dendritic spine density

Not conclusive

PSYCHOLOGICAL SYMPTOMS

DEPRESSION

IRRITABILITY

TIREDNESS / POOR SLEEP

ANXIETY

LOSS OF LIBIDO

FORGETFULNESS

LOSS OF CONCENTRATION

ESTROGENESTROGEN

Cardiovascular

Atherosclerosis

Estrogen reduced Estrogen worsen

Atherosclerosis

EP and vascular protection

Cardiovascular disease

- กลไกการออกฤทธ #ผ�านทาง nongenomic pathway Estrogen endothelial cell

produce nitric oxide vasodilatation and

inhibit platelet adhesion

Estrogen effect - กลไกการออกฤทธ #ผ�านทาง genomic pathway อาศ�ยการจ�บ receptor ของ estrogen

1 ผลต�อ metabolism of lipid-lipiprotein กระต��น LDL receptor ท*�ต�บ และเร�งกระบวนการ LDL catabolism -> LDL LDL ลดลงลดลง 2 ผลต�อระบบ coagulation และ fibrinolysis 3 ผลต�อหลอดเล�อดโดยตรง เช�น vasodilatation

Menopause Increases CVD Risk

ESTROGENESTROGEN

Atrophy

Mucous secretion

Loose collagen

Changes acid/base

Genitourinary changes

Urethral syndrome

ESTROGENESTROGEN

BONE - Estrogen -> tonic suppression of remodeling and

maintain a balance between osteoclastic and

osteoblastic activity

(loss of estrogen->excessive osteoclast activity)

- Induced enhancement of the availability of vitamin

D

- Increase vitamin D receptor in osteoblast

- Decrease the production of bone resorption

cytokine (IL1, IL6) and proteolytic enzyme

Stages of Bone Mass in the Life Cycle of Women

OSTEOPOROSIS

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Definitions

Changes in menopause

Management

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ManagementManagement