C19 - Effects of Ageing on Reproduction

Question 1

What is senescence?

Answer 1

Deterioration of the human body.

Question 2

How do hormone levels change as women age?

Answer 2

Secretion of oestrogen decrease

Secretion of FSH increases

Secretion of LH increases

Question 3

What is an ovarian reserve?

Answer 3

The ability for an ovary to produce oocytes that can be fertilised.

Question 4

What occurs to the ovarian reserve as women age?

Answer 4

The number of oocytes which can be successfully fertilised decreases, decreasing the woman’s fertility level.

Question 5

What is AMH?

Answer 5

Anti-Mullerian hormone secreted by ovarian follicles.

Concentrations of AMH in the bloodstream indicate a woman’s ovarian reserve.

Question 6

What is menopause?

Answer 6

The last time the menstrual cycle occurs due to lack of ovarian follicles.
This is complete once a woman has not had a period for over a year.

Question 7

What does HRT mean?

Answer 7

Hormone replacement therapy

Question 8

What is hormone replacement therapy?

Answer 8

A treatment for relieving the symptoms of menopause.
It replaces female hormones (oestrogen and progesterone) which are at lower levels as menopause approaches and progresses.

Question 9

What are the 2 forms of HRT given?

Answer 9

Unopposed oestrogen

Combined HRT

Question 10

What is unopposed oestrogen? (HRT)

Answer 10

When the woman is provided with oestrogen only.

Question 11

What is combined HRT?

Answer 11

Oestrogen and progestin are given.
Progestin is a synthetic molecule with similar effects to progesterone however it reduces the risk of uterine cancer (which is promoted by oestrogen)

Question 12

How can HRT be administered?

Answer 12

Continuously – the same hormone is taken through each month and doesn’t cause any withdrawal bleeds.

Cyclic regime – oestrogen and progestin taken for 3 weeks then stopped for the fourth, causing the woman to experience withdrawal bleeding.

Question 13

How is HRT administered?

Answer 13

Tablets – taken orally

Skin patches

Implants inserted under skin of the stomach, buttock or thigh.

Vaginal rings

Oestrogen gel applied to skin

Question 14

Advantages and disadvantages of taking HRT:

Answer 14

Advantages:
Prevention of hot flushes

Reduced risk of developing osteoporosis

Prevention of vaginal dryness

Protection against loss of connective tissue

Potential improvement in sleep and reduced muscle ache

Reduced mood swings and depressive symptoms

Disadvantages:
Greater risk of venous thromboembolism (VTE)

Greater risk of a stroke

Greater risk of breast cancer

Greater risk of endometrial (uterine) cancer

Oestrogen has side effects such as fluid retention, bloating, breast tenderness, nausea, leg cramps etc.

Progestin has side effects such as pelvic pain, backache, acne, depression, mood swings etc.

Question 15

What are alternatives to HRT?

Answer 15

Phytoestrogens, chemicals found in plants, which have a similar molecular structure to oestrogen or are converted into oestrogen-like compounds in the gut are prescribed e.g.

Isoflavones – found in soya beans and alfalfa

Lignans – found in cereal grains, fruit and veg

Flavones – found in cereals, celery and herbs

Coumestans – found in split peas and alfalfa.

They have antifungal and antibacterial properties which can reduce the effects of viral infections.
Some also use relaxation therapies e.g. yoga to reduce symptoms.

Question 16

What changes can be made to a woman’s lifestyle to reduce menopausal symptoms?

Answer 16

Do regular exercise

Stay cool at night

Reduce caffeine, alcohol and spicy food intake

Reduce stress levels

Give up smoking

Question 17

What change occurs in the testes as males age?

Answer 17

There’s a decrease in the mass of testicular tissue. There many also be a slight decrease in the level of testosterone.

Question 18

What change occurs with erectile function as males age?

Answer 18

Erectile dysfunction may occur where males cannot get or maintain an erection for intercourse.

Question 19

What changes occur in fertility as males age?

Answer 19

The testes continue to produce sperm but at a slower rate.

The prostate gland, epididymis and seminal vesicles lose some of their surface cells despite continuing to produce semen.

Sclerosis can occur in the epididymis which causes the tissue to become less elastic.

Decline in testosterone production can also reduce libido.

Question 20

How does urinary function change as males age?

Answer 20

Some of the prostate tissue can be replaced with scar tissue, causing the prostate gland to enlarge (known as BPH benign prostatic hypertrophy).

This can lead to issues with ejaculation and urination.

Question 21

What is BPH?

Answer 21

Benign prostatic hypertrophy involves hyperplasia (increase in number of cells) rather than hypertrophy (increase in size of individual cells).

It causes the formation of large nodules that can compress the urethra, restricting the flow of urine from the bladder.

Question 22

How is BPH (benign prostatic hypertrophy) diagnosed?

Answer 22

By rectal examination.
Blood tests for a specific antigen (PSA) are carried out to exclude prostate cancer.

Ultrasonography can also be used.

Question 23

Describe the changes which occur during and after menopause and explain how changes in hormone levels are associated with these changes:

Answer 23

Changes during:

• irregular periods
• hot flushes
• fatigue
• mood changes / irritability / anxiety
• loss of libido

Changes after:
- ovulation stops 
- menstruation stops
- reproductive organs become smaller 
- vaginal, dryness / discharge
- calcium loss from bone / reduction in bone
mass (leading to osteoporosis)
- increase in % body fat ;

Hormonal changes:
- lower concentrations of oestrogen and
progesterone
- higher concentrations of FSH

Question 24

Suggest an active ingredient which may be found in a herbal remedy for menopausal symptoms:

Answer 24

Phytoestrogens

OR
Antioxidants

Isoflavones