9 - Menopause Flashcards
What is the definition of menopause?
- Permanent cessation of menstruation for 12 consecutive months
- When no primary follicles left so oestrogen levels deccline
- “monthly stop”
What is the average age of menopause?
- 45-55 so 50
- Below 40 with abrupt cessation is usually pathological so needs to be investigated
What are the stages of menopause?
- Pre-menopause
- Perimenopause
- Menopause
- Post-menopause
What happens in pre and perimenopause?
- Pre: Initial changes in menstrual cycle, may be shorter or ovulation may be early or absent. Oestrogen falls so FSH and LH rise, FSH more, but cycle normal. Around 40 and reduced fertility
- Peri: Transition phase where physiological changes like hot flushes and mood swings so infrequency of menstruation
What happens in menopause and post menopause?
- Menopause: Permanent cessation of menstruation for 12 months
- Post: After 12 months. No longer able to concieve like in pre and perimenopause
What happens to the quality and quantity of oocytes as we age?
Both decline
What happens to the levels of gonadotrophins during menopause?
- Oestrogen levels fall due to no follicles
- No inhibin either
- LH and FSH, especially FSH rise rspidly
What hormone is used to diagnose menopause?
FSH
What is responsible for all of the horrible symptoms of menopause?
- Mostly oestrogen deficiency
- Different symptoms in early, intermediate and late stages
What are some symptoms that can occur in early stages of menopause?
- Hot flushes and sweating
- Insomnia
- Mood swings and depression
- Irregular menstruation
What are some symptoms that can occur in the intermediate of menopause?
- Vaginal atrophy leading to dyspareunia
- More UTIs and stress incontinence
- Reduction of pubic hair due to lowered testosterone
- Loss of vaginal rugae
- Breast tissue reduce in size
- Loss of skin elasticity
- Changes to hair and voice
- Bloating and constipation as low motor activity
If a postmenopausal woman presents with symptoms of vaginal bleeding, what should you investigate into?
- Endometrial carcinoma as no progesterone being produced so woman is subject to unopposed oestrogen
If a woman of post-menopausal age presents to you with bloating, what diagnosis should you consider?
- Ovarian cancer
- Ask if they were on HRT as link between the two
What are some disease processes that can occur in the post menopausal woman?
- Increased risk of osteoporosis, athersclerosis and Alzheimer’s disease.
Why are post menopausal woman at risk of osteoporosis?
Oestrogen inhibits osteoclast activity so without it calcium loss from bone. Lose bone mass and bone height
Why are post menopausal woman at risk of CVS disease?
- Low levels of oestrogen and progesterone change the lipid profiles
- Increases circulating lipid levels so at risk of atherosclerosis, MI and stroke
What is a hot flush?
What changes occur to the internal genitals during menopause?
- Ovaries shrink due to less oestrogen. Some aromatisation occurs to keep oestrogen level up
What changes occur to the external genitals in menopause?
What changes occur to the general appearance of a woman in menopause and her digestive/urinary system?
- Constipation due to reduced motor activity
- Thinner less elastic bladder and loss of pelvic tone so urinary incontinence
- UTIs
What are the risks and benefits of HRT?
Benefits
- Can improve wellveing
- Can limit osteoporosis
- Endometrial cancer risk only in oestrogen-only HRT
Risks
- Ovarian and Breast cancer
- Not advised for cardioprotection
- Blood clots
What roles do oestrogen and progesterone have in the body, apart from its roles in the reproductive tract?
What are some signs of Turner’s syndrome and what health problems are they at risk of?
- Diabetes
- Hypertension due to kidney and heart issues
- Low IQ
- Abnormal bone development
- Thyroid issues (hypo)
What are some causes of menorrhagia?
- Endometriosis
- Fibroids
- Coagulation disorders
- Drugs like warfarin
