Physical Therapy for Women: Menopause and Osteoporosis

Menopause

• Menopause is defined as the permanent cessation of menstruation for at least 6 months to one year due to intrinsic ovarian failure, resulting in follicular inactivity.
• Climacteric is a period of gradual changes (decline) of ovarian function, starting long before menopause and continuing thereafter for a while.
• Climacteric period includes perimenopause, menopause, and postmenopause.

Different Types of Menopause

• Natural menopause: occurs when ovaries naturally stop producing eggs.
• Premature menopause: occurs when ovaries stop producing eggs before the age of 40.
• Induced menopause: occurs when ovaries are surgically removed or damaged by radiation or chemotherapy.

Changes Occurring in Menopause

• Hyperfunctioning of pituitary gland anterior lobe, leading to increased appetite and altered carbohydrate metabolism.
• Spontaneous decrease in activities, energy expenditure, and metabolic rate.
• Increased risk of type II diabetes.

CNS and Psychological Changes

• Impairment of mental functions, causing dementia.
• Anxiety, mood swings, and sleep disturbances.
• Depression due to decreased serotonin synthesis and increased catabolism.

Genitourinary System Changes

• Ovaries: become small, fibrous, and unresponsive to gonadotropins.
• Uterus: becomes small, with endometrial hyperplasia.
• Vagina: atrophy and thinning of mucosa, leading to irritation, itching, and dyspareunia.
• Pelvic floor muscles and ligaments: decreased muscle tone, decreased elasticity, and pelvic floor dysfunction.

Endocrinal Changes

• FSH levels: increase (> 10 IU/L) with declining ovarian function, and increase further (> 20 IU/L) with ovarian insufficiency.
• Estradiol levels: decrease with ovarian insufficiency.
• Inhibin levels: decrease, leading to increased FSH production.
• Anti-Mullerian hormone: becomes undetectable.
• Progesterone levels: decrease.
• Androgen levels: increase.

Cardiovascular Changes

• Protective effects of estrogen on circulation and blood vessels are lost.
• Atherosclerosis, hypertension, and strokes may occur.
• Vasomotor changes (hot flashes) occur due to estrogen fluctuations and withdrawal.

Vasomotor Changes (Hot Flashes)

• Hot flashes affect around 85% of women and present as episodic heat waves, followed by cold sweats.
• Hot flashes can disturb sleep, leading to increased heart rate, palpitation, headache, and dizziness.
• Grading of hot flashes is important for planning management and follow-up.

Musculoskeletal Changes

• Protective effects of estrogen on the musculoskeletal system are lost.
• Estrogen deprivation leads to increased frequency of knee, hip, and finger osteoarthritis.
• Identified estrogen receptors (ERs) in normal and osteoarthritic cartilage.
• Musculoskeletal pain increases pre and post menopause.

Osteoporosis

• Osteoporosis is defined as low bone mineral density, leading to compromised bone strength.
• Advanced age and decreased estrogen production lead to decreased bone mass.
• Exercises, supplements, nutrition, and counseling can help prevent osteoporosis.

Management of Menopause

• Treatment options include hormonal replacement therapy, selective estrogen receptor modulators (SERMs), and medical therapy.
• Prevention strategies include lifestyle modifications, physical exercises, and electrotherapy.
• Hormonal therapy is indicated for symptomatic menopausal women, premature or induced menopause, and preventing osteoporosis.
• Contraindications for hormonal therapy include breast or endometrial cancer, active liver disease, uncontrolled hypertension, and thromboembolic diseases.

Hormonal Therapy

• Benefits of hormonal therapy include symptoms relief, prevention of urogenital atrophy, and decreased risk of colonic cancer.
• Physical exercises can help with cardiovascular health, obesity, depression, and osteoporosis.
• Electrotherapy options include electromagnetic field, pulsed ultrasound, and ultraviolet device.