13. Menopause The end of female menstruation and fertility. These changes can begin as early as age 35 or as late as 59.
14. Symptoms of Menopause Hot flushes - sudden warmth and then sweating; affecting about 75% of women. o Sudden facial warmth o Facial flushing o Facial tingling o Flush spreads to neck and/or body o Cold sweat - usually after the flush subsides
15.
16. Uterovaginal prolapse Is the downward displacement of the vagina and uterus, which is common and disabling condition. There are three stages of prolapse depending on the degree of descent of the uterus. Grade III is otehrwsie called procidentia where in the whole uterus lies outside the vaginal introitus.
17. The vaginal prolapse alone can occur without the descent of uterus. The terms cystocoele or urethrocoele are applied when the upper or lower portion of the anterior vaginal wall descends along with the underlying structure i.e., the bladder or urethra respectively. Similarly, the posterior vaginal wall prolapse in termed rectocoele or enterocoele where in rectum or a loop of intestine can herniate into the prolapse. Uterine prolapse is usually combined with vaginal prolapse where as the latter can occur independently.
18. Normal supports of uterus and vagina The uterus and vagina are kept in position in the pelvis by several supporting ligaments and muscles which acts as opes on either side of the uterus to keep it in position. The transverse cervical ligaments on either side and utero sacral ligaments at the back, form the chief supports of uterus. The round ligaments are less important supports. All these ligaments act like spokes of a bicycle wheel. Each is weak by itself but together forms a strong mechanism.
19. The levator ani is a large sheet of thick strong muscle which spreads to form the floor of the pelvis. In the middle of which three important structures pass through. They are rectum, urethra, and uterine cervix. The firm attachments of levator ani to pelvis bones and its muscular tone support the three canals. The other muscles of importance are the perennial muscles and the muscles of utogenital diaphragm. All three groups of muscles are important in controlling the mechanism of urinary continence and defecation.
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