5. Menopause Flashcards
What is menopause?
Permanent cessation of menstruation at the end of reductive life sue to loss of ovarian follicular activity
The time when there has been no menstrual periods for 12 consecutive months and no other biological or physiological cause
When does physiological menopause usually happen?
Normal decline in ovarian function due to ageing begins in most women between ages 45 and 55
What is pathological menopause?
Gradual or abrupt cessation of menstruation before 40 years, occur idiopathically
What is the menopausal phase broken down into?
- Pre-menopause - slight changes to FSH/LH bu cycle will be relatively normal
- Peri-menopausal - changes to cycle
- Menopause
- Post menopause
What happens in pre-menopause?
Typically from age 40+ Slightly less oestrogen secreted LH and FSH levels may rise, FSH more May be reduced negative feedback Cycles relatively unchanged
What happens in peri-menopause?
Characterised by physiological changes associated with end of reproduction capacity - follicular phase shortens, ovulation early or absent
Terminating with completion of menopause
What is post-menopause?
Defined formally as time after which a woman has experiences 12 consecutive months of amenorrhoea
What are the physiological symptoms of menopause?
Itching - psoriasis Restless limbs Change in body temperature - increased sweating Sleep changes Bloating Mood changes and forgetfulness
What are the consequences of oestrogen deficiency in early menopause?
Hot flushes Sweating Insomnia Menstrual irregularity Psychological symptoms
What are the consequences of oestrogen deficiency in intermediate menopause?
Vaginal atrophy
Dyspareunia
Skin atrophy
Urge-stress incontinence
What are the consequences of oestrogen deficiency in late menopause?
Osteoporosis
Atherosclerosis
Alzheimer’s disease
What are the effects on the vasomotor system during menopause?
Vascular changes
Transient rises in skin temperature and flushing
Relieved by oestrogen treatment
What are the observations in dysfunctional 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
What is dysfunctional uterine bleeding caused by?
Changes in oestrogen
- causes endometrium to keep thickening
- leads to a later menstrual period followed by irregular bleeding and spotting
- greater thickening (hyperplasia)
- no corpus luteum = no progesterone
- increased risk of carcinoma as unopposed oestrogen
What are the psychological changes associated with menopause?
Frequent headache
Irritability
Fatigue
Depression and insomnia
What are the changes to the ovary in menopause?
Ovaries become smaller
- oestrogen production decreases
- substantially increased gonadotrophin levels maintain ovarian androgen secretion despite substantial oestrogen demise
What are the changes in the skin in menopause?
Skin loses its elasticity and becomes thin and fine, due to loss of elastin and collagen from skin
What are the changes to weight in menopause?
Weight increase is more likely to be the result of irregular food habit due to mood swing, more deposition of fat around hips, waist and buttocks
What are the changes to hair in menopause?
Hair becomes dry and coarse after menopause, may be hair loss due to decreasing level of oestrogen
What happens to the voice in menopause?
Voice becomes deeper due to thickening of vocals cords
What happens to the GI tract in menopause?
Motor activity of the entire digestive tract is diminished after menopause
- intestines tend to be sluggish resulting in constipation
What happens to the urinary system in menopause?
As oestrogen level decreases after menopause , tissue lining urethra and ladder becomes drier, thinner and less elastic
- changes in bladder
- loss of pelvic tone
- urinary incontinence
- lead to increased frequency of passing urine as well as increased tendency to develop UTI
What are the changes in the uterus in menopause?
Uterus can become small and fibrotic due to atrophy of muscles
Regression of endometrium
Shrinkage of myometrium
Cervix become smaller and appears to become flush (closer) with vagina
Thinning of cervix and vaginal rugae lost
What are the changes in the vulva in menopause?
Fat in labia major and mon pubis deceases and pubic hair becomes spare
What are the changes in breasts in menopause?
In thin built women the breast become flat and shrivelled
In heavy built women they remain flabby and pendulous
What impact does menopause have on bones?
Calcium loss from bone is increased in first 5 years after onset of menopause - loss of bone density
Bones liable to fracture
Reduced oestrogen enhances osteoclast ability to absorb bone
Osteoporosis
What is he impact of menopause on cardiovascular system?
Lack of oestrogen and progesterone causes changes in metabolism of body
Increased cholesterol level in blood, hyperlipidaemia
Gradual rise in risk of heart disease and stroke
What are some non-hormonal interventions for menopause?
Dressing in light layers, avoiding caffeine, alcohol and spicy foods can minimise hot flushes and night sweats symptoms
Menopause and weight gain tend to go together due to lifestyle changes
- Reducing dietary fat intake and regular exercise
What is the role of HRT?
Used to overcome the short-term and long-term consequences of oestrogen deficiency
How can HRT be administered?
In pill form
Vaginally (cream, good for urinary symptoms)
Trans-dermally (patch)
