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Reproductive module > ✓ 31- Menopause and Premature Ovarian Failure > Flashcards

✓ 31- Menopause and Premature Ovarian Failure Flashcards

1
Q

What is the average of menopause in Kuwait?

A

51

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2
Q

What is the landmark for menopause?

A

Final menstrual period

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3
Q

Define Perimenopause

A

Menopause transition + 1 year after FMP

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4
Q

Define Early and Late Postmenopause

A

Early: 5-8 years following FMP
Late: rest of life

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5
Q

What are the stages of menopausal transition?

A

Early and Late menopausal transition

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6
Q

Define Early and Late Menopausal transition

A

Early: variable duration
Late: 1-3 before FMP

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7
Q

What is the clinical definition of menopause?

A

menopause recognized after 12 years months of secondary amenorrhea

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8
Q

Epidemiology of Menopause [Age]

A

Average age = 51

5% after 55 and 5% between 40 and 45

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9
Q

What is the definition of POF/I?

A

Menopause before age of 40

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10
Q

What genetic factors affect early menopause?

A

Family history
Genes that regulate immune function and DNA repair Genetic variation in the estrogen receptor gene
FMR1 permutation (fragile X mental
retardation)

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11
Q

How does (fragile X mental retardation) affect menopause?

A

Associated with POF/I

Earlier menopause by up to 7 years

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12
Q

What factors affect early menopause?

A 
Genetics
Ethnicity 
Smoking 
Hysterectomy with ovarian consideration 
Other 
T1DM
In-utero exposure to DES
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13
Q

How does smoking affect menopause?

A

Earlier menopause up to 2 years

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14
Q

Ethnicity and Menopause

A

Hispanic < Caucasian < Japanese-American women

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15
Q

How does a Hysterectomy with ovarian consideration cause menopause?

A

blood supply in the ovaries decreases, which accelerates the atresia that occurs in the follicles.

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16
Q

What are the three main steps in ovarian development?

A

Germ cell differentiation
Continuous follicular growth
Continuous follicular atresia

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17
Q

When does Germ cell differentiation occur?

A

At week 4-8 of development

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18
Q

Compare the antral follicles in adults and children/fetuses

A

Antral follicles is larger in children/fetuses, these are formed in response to low levels of pulsatile FSH and LH, unlike after puberty

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19
Q

What causes atresia?

A

apoptosis

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20
Q

What reduces the number of oocytes before birth?

A

Atresia

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21
Q

At which age does accelerated atresia occur?

A

> 37 years

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22
Q

How many oocytes are found at menopause?

A

1000 oocytes, but most atresic

23
Q

At which age do females have the highest numbers of oocytes?

A

Female fetus at 20 weeks

24
Q

How many oocytes are found at puberty?

A

200,000

25
Q

What is the reproductive age?

A

15-45 years [first couple of cycles after puberty and last couple of cycle prior to menopause are anovulatory]

26
Q

At which age do we see a rapid decline in number of follicles?

A

at 37

27
Q

What is the first hormonal changes seen in early menopause and what does that correlate with?

A

Fall in Inhibit B, correlates with decrease in developing follicles

28
Q

What hormonal changes are seen in early menopause?

A 
↓ Inhibit B
↓ AMH
↑ FSH 
↑LH
↑ Estrone 
↓ Progesterone
29
Q

What are the late symptoms of menopause?

A 
Bone loss
 Cardiovascular disease (CVD)
Degenerative arthritis
 Body composition
 Skin changes
 Balance
Pelvic organ prolapse
Urinary incontinence
30
Q

What are the early symptoms of menopause?

A 
Hot Flashes 
Sleep disturbances
Depression
 Vaginal dryness & dyspareunia
Painful intercourse
 Sexual dysfunction
 Cognitive impairment (memory & concentration)
Joint pain
Breast pain
 Migraines
31
Q

What are three mechanisms in which estrogen deficiency may cause bone loss?

A

Increases bone remodeling rate
Increases osteoclasts and osteoblasts numbers [more osteoclasts]
Increases resorption and formation [more resorption]

32
Q

How can estrogen effect bone?

A

↓ birth rate of osteoclasts
↑ osteoblasts progenitors in bone marrow
↑ pro-apoptotic effects on osteoclasts
↓ anti-apoptotic effects on mature osteoblasts & osteocytes

33
Q

What is the t-score of osteopenia, osteoporosis and severe osteoporosis?

A

Osteopenia → between -1 and -2.5
Osteoporosis → -2.5 and below
Severe Osteoporosis → -2.5 and below + fragility fracture

34
Q

What changes in lipid profiles is seen in post-menopausal women?

A

Small increase in LDL

No change in HDL, but decreased protective effects

35
Q

Define POF/I

A

The development of primary hypogonadism

in females before the age of 40 years

36
Q

Epidemiology of POF/I

A

1 in 250 by age 35 years

1 in 100 by age 40 years

37
Q

What is the pathophysiology of POI/F?

A

Unknown etiology [>75%]
Accelerated follicle depletion
Abnormal follicular stimulation

38
Q

What genetic defects cause accelerated follicular atresia?

A

Turner’s Syndrome
Fragile X Syndrome
X chromosome deletions and translocation
Galactosemia

39
Q

What ovarian toxins cause accelerated follicular atresia?

A

Radiation
Mumps/CMV
Chemotherapeutic drugs [Alkylating agents]

40
Q

What intraovarian modulators cause abnormal follicular stimulation?

A

BMP 15 [Polymorphism of Inhibit alpha subunit]

41
Q

What steroidogenic enzyme defects cause abnormal follicular stimulation?

A

CYP17 deficiency [StAR mutation]

Aromatas gene mutations

42
Q

What gonadotropin receptor function cause abnormal follicular stimulation?

A

FSH receptor mutations

Gs Alpha subunit gene mutations

43
Q

Management of Autoimmune Oophoritis

A

HRT til 50 years [normal age of menopause]
Fertility
IVF with oocyte donation
Glucocorticoids

44
Q

Investigations of Autoimmune Oophoritis

A

21-hydroxylase or anti-adrenals antibodies

Ovarian biopsy is unnecessary

45
Q

What other condition has the same antibodies seen in autoimmune oophoritis?

A

Asymptomatic adrenal sufficiency

46
Q

What antibodies are found in autoimmune oophoritis?

A

21-hydroxylase or anti-adrenals antibodies

47
Q

Describe hot flashes

A

A sudden sensation of heat centered on the upper chest & face that rapidly becomes generalized, lasting 2-4 minutes.

48
Q

What is the frequency of hot flashes attacks?

A

Occur 1/2 per day OR 1 per hour
Continues > 1 year [80%]
Resolves spontaneously within 4-5 years if left untreated

49
Q

What do low serum AMH concentration indicates?

A

predictive of a poor ovarian response to exogenous
gonadotropin stimulation

marks a critical juncture in the timing of the menopausal transition

50
Q

What hormonal changes indicate a decline in follicular numbers?

A

Inhibit B and AMH

51
Q

What changes are seen in the Hypothalamic-Pituitary axis during the perimenopausal years?

A

Decreased sensitivity to estrogen

Failure of positive feedback of E on LH
normal preovulatory levels of estrogen, but no LH surge

Failure of negative feedback of E on LH
normal follicular phase estrogen levels do not suppress LH secretion

52
Q

What is the cause of follicular atresia in fetus and adults?

A

Fetus:
apoptosis of oocyte
Adult:
Granulosa cell apoptosis

53
Q

Describe follicular atresia in young girls

A

most follicles that reach the pre-antral (1 mm) stage are

already atretic, with the rate of atresia is increased in larger follicle

Reproductive module (41 decks)

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