9 Menopause Flashcards
Define menopause.
Permanent cessation of menstruation and end of reproductive life due to loss of ovarian follicular activity. No menstrual periods for 12 months ands no other biological and physiological cause can be identified
What is the normal age range for menopause to occur?
45 and 55 (average is 50)
What is pathological menopause?
Gradual or abrupt cessation of menstruation before 40 yrs (idiopathically) (eg premature ovarian failure)
Give an example of what may cause surgical menopause
Removal of ovaries
What are the 4 categories which menopause is broken down into?
1, Pre-menopause - 2, Peri-menopause, - 3, Menopause -4, Post-menopause
What occurs during Pre-menopause? (Time prior to menopause)
From around 40yrs + Slightly less oestrogen secreted LH and FSH rise (FSH more) May be reduced fertility
What occurs during Peri-menopause? (Transition phase) (Aka climacteric)
End of reproduction capacity Follicular phase shortens Ovulation early or absent
What happens during the (menopause phase)
Permanent cessation of menstruation Ovarian follicular development
What occurs during the post-menopausal phase?
Time after which women has experienced 12 consecutive month of amennorhea
As the number of primordial follicles decreases throughout reproductive life, what happens to the production of oestrogen by the ovaries?
Oestrogen production falls
What happens to the proportion of poor quality oocytes as the number of follicles decreases with age?
% of poor quality follicles increases
In menopause both FSH and LH are raised due to the lack of negative feedback. Which of these is higher during menopause?
FSH higher than LH
As no inhibin (inhibin only acts on FSH)
At a cellular level, what causes menopause?
Ovaries depleted of follicles
No amount of gonadotrophin stimulation can make them work
Oestrogen levels fall
FSH and LH rise
(No inhibin)
What hormone is measured to diagnose physiological menopause?
FSH
What are some of the symptoms of menopause?
- Hot flushes
- Itching
- Sweating
- Fatigue
- Bloating
Why can menopause cause bloating?
Oestrogen helps with smooth muscles tone/definition
Loss of oestrogen- loss of smooth muscle tone
What are some of the symptomatic consequences of oestrogen deficiency? (14)
Menopause can cause dysfunctin in uterine bleeding. (eg spotting, heavier and longer periods etc). Explain why this is?
Changes in oestrogen
Can cause endometrium to keep thickening–> late period then spotting
No corpus luteum so no progesterone if no ovulation
List some of the physiological symptoms that occur as a result of menopause.
Name the enzyme that converts androgens to oestrogen in the ovaries and in adipose tissue.
Aromatase
What happens to the size of the ovaries as a result of menopause?
Ovaries atrophy
What changes might occur in a woman’s general appearance as a result of menopause? (4)
- Skin
- loses elasticity- loss of elastin and collagen
- Weight increase
- Irregular food habits
- Deposition of fat changes
- Hair
- Drier and coarser
- Voice
- Deeper- thickening of vocal cords
Explain why menopause can cause constipation.
Motor activity of digestive tract diminished
Why can menopause cause urinary incontinence and increased tendency to develop UTIs?
- Loss of oestrogen
- Bladder and urethra tissue lining= thinner, drier, less elastic
- Loss of pelvic tone
What happens to the structure of the uterus, cervix and vagina as a result of menopause?
Uterus:
small and fibrotic
atrophy of muscles–>shrinkage of myometrium
regression of endometrium
Cervix:
Thinning- may be difficult to differentiate from vagina
Vagina:
Rugae lost
What happens to the external genital organs as a result of menopause (vulva and breast)?
Vulva:
fat in labia majora and mons pubis decreases
pubic hair thins
Breast:
Thin women: flat and shrivelled
Heavy women: flabby and pendulous
Why dos calcium loss from bones increase after the onset of menopause?
Reduced oestrogen- enhances osteoclast activity
Loss of bone density
Why does the risk of heart disease and stroke increase after menopause?
Lack of oestrogen and progesterone
- Increased cholesterol and lipid level in blood
- Increased BP
- Body weight increased and body fat distibution more central
- Carbohydrate tolerance decreases
- Insulin resistance increases, sensitivity decreases
Useful:
How can the symptoms of menopause be treated?
- Lifestyle modifications
- Lighter layers
- Control diet
- More exercise
- Avoid caffeine and alcohol
- HRT
- Pill/patch/cream
- Cream may help with tone- help with urinary incontinence
- Limit osteoporosis
- Pill/patch/cream
What is it important to check for in patients who have post menopausal bleeding?
Endometrial carcinoma
What are the risks of HRT?
Risks change with age and risks exponential
