10- The end of reproductive life Flashcards
what is mensopause
the ceasing of menstruation.
greek menopause translation
- From the Greek “mens” meaning “monthly’’ and
- “pausis” meaning “cessation”.
- Menopause is a part of a women’s natural ageing process
- It is when her ovaries produce lower level of the oestrogen and progesterone
- She is therefore no longer able to become pregnant.
basic physiology behind menopause
Normal decline in ovarian function due to ageing begins in most women between ages 45 to 55 on average 50
Results in infrequent ovulation
Decreased menstrual function and eventually cessation of menstrual function and eventually cessation of menstruation
2 definitions for menopause
- Permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity
- Defo of menopause: defined as the time when there has been no menstrual periods for 12 consecutive month and no other biological or physiological cause can be identified
early menopause
premature menopause
Physiologic menopaus
Pathologic menopause
The gradual or abrupt cessation of menstruation before 40 years occurs idiopathically in about 5% of women in USA
how many menopausal phases
Phase broken down into four categories
- Premenopausal slight changes in FSH/LH levels but cycle will be relatively normal)
- Peri-menopausal (transition menopause starts to happen to the cycle)
- Menopause
- Post menopause
FSH is big indicator that menopause is taking place- but no follicle left to stimulate
pre-menopause definition
peri-menopause
climacteric
physiological period in a womens life where there is regression of ovarian function
post menopause
which hormone is the biggest indicator that menopause is taking place
reproductive ageing graph
why do levels of oestrogen decrease before and during menopause
- by 45 years old only a few primordial follicles (producing oestrogen) remain to be stimulated by FSH and LH
*
why do we see an increase in FSH (esp) and LH
When oestrogen production falls below a critical value (few primordial follicles remaining) the oestrogens can no longer inhibit production of gonadotrophin (FSH and LH)
as women age the quantitu and quality of ovarian follicle pool
summary of the cause of menopause
Menopause occurs when the ovaries are totally depleted of follicles and no amount of stimulation from gonadotrophins (LH and FSH) can force them to work
i.e primary ovarian failure
Cessation of menstrual cycles
Average age ~50, but variable
No more follicles to develop
Oestrogen levels fall dramatically
FSH & LH levels rise, FSH dramatically
No inhibin
FSH levels rise dramatically due to there being
no inhibin
gonadotrophins (LH and FSH) during menopause
physiological symptoms of menopause
bloating caused by
Loss of oestrogen = loss of smooth muscle tone in the gut, leads to bloating or constipation
Physiological symptoms
- Itching- psoriasis
- Restless limbs
- Change in body temperature- increased sweating
- Sleep changes – feel more sleepy during the day (due to restless nights? See temp changes)
- Bloating
- Mood changes
mood changes and forgetfullness caused by
Psychological changes- oestrogen and serotonin
- early consequences of loss of oestrogen
- hot flushes
- sweating
- insomnia
- menstrual irregularity
- psychological symptoms
intermediate consequences of loss of oestrogen
- vaginal atropy
- dyspareunia
- skin atrophy
- urge-stress incontinence
late consequences of loss of oestrogen
osteoporosis
atherosclerosis
CHD
Cardiovascular disease
Alzheimers
what are hot flushes driven by
The hot flush driven by effects on the vasomotor system
- Vascular changes
- Effects 80% to some degree
- Transient rises in skin temp and flushing
- Relieved by oestrogen treatment
The hot flush driven by effects on the vasomotor system
- Vascular changes
- Effects 80% to some degree
- Transient rises in skin temp and flushing
Relieved by oestrogen treatment
symptoms of dyfunctional uterine bleeding
Spotting between cycles
Extremely heavy bleeding
Mid-cycle bleeding
Longer, shorter, or unpredictable lengths of time between periods
Longer, shorter or unpredictable durations of periods
cause of dyfunctional uterine bleeding
Changes in Oestrogen
Causes the endometrium to keep thickening
Leads to a late menstrual period followed by irregular bleeding and spotting
Greater thickening – hyperplasia
No corpus luteum= no progesterone
Increased risk of carcinoma (unopposed oestrogen) aromatisation
changes in oestrogen and dysfunctional uterine bleeding
Causes the endometrium to keep thickening
Leads to a late menstrual period followed by irregular bleeding and spotting
Greater thickening – hyperplasia
No corpus luteum= no progesterone
Increased risk of carcinoma (unopposed oestrogen) aromatisation
The psychological changes are mainly manifested by
- frequent headache
- irritability
- fatigue
- depression and insomnia
psychological changes thought to be less related to hormones and more related to
more likely to be related to the loss of sleep due to night sweat.
Diminished interest in sex may be due
to emotional upset or may be secondary to painful intercourse due to a dry vagina.
changes to the ovaries
The ovaries become smaller (atrophic)
- Oestrogen production decreases
- Will have produced small amount of androgen during reproductive life
- Important as aromatase converts androgens to oestrogens in ovary and adipose tissue
- After menopause the substantially increased gonadotropin levels maintain ovarian androgen secretion despite substantial oestrogen demise
changes to skin
The skin loses its elasticity and becomes thin and fine. This is due to the loss of elastin and collagen from the skin.
changes in weight
weight increase is more likely to be the result of irregular food habit due to mood swing . There is more deposition of fat around hips, waist and buttocks.
hair changes
Hair become dry and coarse after menopause . There may be hair loss due to the decreasing level of oestrogen.
voice changes
Voice become deeper due to thickening of vocal cords.
GI tract changes
Motor activity of the entire digestive tract is diminished after menopause.
The intestines tend to be sluggish resulting in constipation.
changes to the urinary system
As the oestrogen level decreases after menopause, the tissue lining the urethra and the bladder become drier, thinner and less elastic .
- Changes in bladder
- loss of pelvic tone (see pelvic floor lecture)
- Urinary incontinence
- This can lead to increased frequency of passing urine as well as an
increased tendency to develop UTI.
changes to the uterus
•The uterus can become small and fibrotic due to atrophy of the muscles after the menopauses
changes to the cervix
•The cervix become smaller and appears to become flush (closer) with vagina. In older women the cervix may be very difficult to identify separately from vagina
Thinning of cervix
Vaginal rugae lost
vulva changes
The fat in the labia majora and the Mons pubis decreases and pubic hair become sparse.
breast changes
- In thin built women the breast become flat and shrivelled
- In heavy built women they remain flabby and pendulous
Menopause causes significant changes in bone
- Calcium loss from the bone is increased in the first five years after the onset of menopause, resulting in a loss of bone density.
- The calcium moves out of the bones, leaving them weak and liable to fracture at the smallest stress.
- Bone mass reduces by 2.5% per year for several years
- Reduced oestrogen enhances osteoclast ability to absorb bone
- Osteoporosis (reduced osteoclast activity)
- Much greater in some than others
- Major reason for fractures in later life
- Can be limited by oestrogen therapy
why is calcium loss from the bone increased in the first five years after the onset of menopause, resulting in a loss of bone density?
Reduced oestrogen enhances osteoclast ability to absorb bone
Osteoporosis (reduced osteoclast activity)
reduction in bone density can be reduced by
oestrogen therapy
alendronic acid
cholesterol changes
Increased cholesterol level in the blood: Hyperlipidemia or an increase in the level of cholesterol and lipids in the blood is common.
–> due to lack of oestrogen and progesterone
cardiovascular system changes due to lack of oestrogen and progesterone
- Cardiovascular disease
- The lack of oestrogen and progesterone
causes many changes in women’s physiology that affect their health and well-being .
changes in the metabolism of the body.
Increased cholesterol level in the blood: Hyperlipidemia or an increase in the level of cholesterol and lipids in the blood is common.
•Gradual rise in the risk of heart disease and stroke after menopause
body composition changes
women gain fat mass and lose lean body mass
glucose metabolism changes
insulin resistance increases
insulin sensitivity decreases
interventions to limit the symptoms of menopause
- There are variety of menopausal treatments both natural and medical that can alleviate the symptom of menopause:
- Dressing in light layers can alleviate hot flashes and night sweats; avoiding caffeine, alcohol and spicy foods can also minimize these symptoms.
- Menopause and weight gain tend to go together due to life style changes than to the hormonal changes .
- Reducing dietary fat intake and regular exercise help to combat weight gain during menopause.
•HRT can be administered
•HRT can be administered orally
in pill form,
Vaginally (oestrogen as a cream: can help with UI),
Trans-dermally (in patch form)
how does HRT work
•Due to it replacing female hormones produced by the ovaries, hormone
replacement therapy minimises menopause symptoms. It can be used before, during and after menopause.
- Can improve well-being
- Can limit osteoporosis
Current advice no longer recommended for first line protection
• Not advised for cardio-protection
