CH 59 Menopause & Postmenopause Flashcards
Perimenopause/menopausal transition what does it mean
part of climacteric before the menopause occurs. menstrual cycle will be irregular
What happens during the perimenopausal state
cycle length decreases due to shortening of follicular phase. ovary functioning is altered. FSH is extremely elevated at the beginning of the follicular phase (caused by inhibin) then falls as estradiol increases. LH levels remain unchanged from younger women’s levels. Cycles are shorter and further apart
Physiologic menopause
oocytes responsive to gonadotropins disappear from the ovary, and the few remaining oocytes don’t respond to gonadotropins. Avergae age, 50-51
premature menopause
menopause before age 40. causes are unknown. Damage to the ovarian follicular structures due to severe infections and tumors can cause this. Also can happen due to exposure to ionizing radiation, chemo, alkylating agents and surgical procedures that impair ovarian supply
Artificial menopause
permanent cessation of ovarian function brought on by surgical removal of the ovaries or by radiation therapy.. Used as treatment for endometriosis. Can be caused by oophrectomy (used to prevent ovarian cancer)
Androstenedione
primary ovarian androgen, reduction in postmenopausal women by 50%: reflects absence of follicular activity.
testosterone levels in postmenopausal women
not much change in levels. production rate is only 1/3 less than in younger women, UNLESS they get oophrectomy (causing 60% decrease). No change in clearance rate. 15% of androstenedione is converted to testosterone. Postmenopausal ovary produces more testosterone than premenopausal ovary
What causes defeminization, hirsutism, and virilism in some older women
increased ovarian testosterone secretion, coupled with reduction in estrogen production and decrease in sex hormone binding globulin (SHBG)
DHEA and DHEAS levels in postmenopausal women
Secreted by adrenal glands. levels are decreased by 60% and 80% with age.
Estradiol in postmenopausal women
greatest decrease up to 1 year after last menstrual period. greatest decrease comes from adrenal glands.
Progesterone in postmenopausal women
major source is ovarian corpus luteum after ovulation, levels decrease by 70%.
Gonadotropins in postmenopausal women
both LH and FSH rise substantially. Ovarian steroids and inhibin on gonadotropins is absent. Also occurs in women with hysterectomy without oophrectomy
reproductive tract changes with menopause
atrophy of vaginal epithelium related to estrogen changes. vaginal rugae flatten and epithelium thins (leads to atrophic vaginitis). Cervix becomes atrophic, smaller, stenotic, and dry (causing dyspareunia). Uterus shows atrophy of endometrium and myometrium. Endometriosis and fibroid symptoms decrease or disappear. May have spontaneous bleeding. Ovaries get smaller (palpable ovary after menopause is suspicious for neoplasm)
Urinary tract changes with menopause
estrogen deficiency produces atrophic changes in bladder and urethra. may see atrophic cystitis, recurrent UTIs, loss of urethral tone, occasional hematuria, dysuria. Treat with vaginal estrogen.
Mammary gland changes with menopause
regression of breast size. Breast pain, cyst formation that comes with menses disappears
prevention of menopause
It cannot be prevented, postponed, or slowed. Artificial menopause can be prevented with avoidance of ionizing radiation. Elective removal of ovaries will cause artificial menopause
atropic vaginitis what is it and diagnosis
thinned epithelium, red and patchy vagina, brown discharge, disappearance of lactobacilli, vaginal burning and soreness, trauma associated with coitus or exam, urinary complaints. Diagnosis based on symptoms.
Hot flashes what is it
sudden flushing and perspiration, sensation of pressure in head, palpitations, weakness, fatigue. Can last up to 10 minutes. severe flushes can take up to an hour and happen 1-2 times per hour or week. Caused by alterations in cutaneous vasodilation, perspiration, reduction of core temp and elevations in pulse rate.
atropic vaginitis treatment
treat with water soluble and/or topical vaginal estrogen, and systemic estrogens
hot flashes treatment
Treated with estrogen, progestin, clonidine. SSRIs (like paxil and fluoxetine), Tibolone, and black cohosh have more risk than benefit (related to breast CA). Gabapentin works well but has level of sedation.
Osteoporosis
systemic skeletal disorder characterized by low bone mass and deterioration of bone tissue. Caused by cessation of ovarian function (estrogen). occurs more frequently in white women, and those with early oophrectomy or premature ovarian failure. increases risk for fractures. Diagnose with bone density test
Osteoporosis prevention and treatment
calcium consumption, vitamin D, biphosphates (alendronate, Risedronate), calcitonin (100IU), estrogen, parathyroid hormone, raloxifene, denosumab, progestins
Sexual dysfunction
hypoestrogenemic state leads to atrophy of the internal genitalia. Most obvious sign is vaginal atrophy, suboptimal sexual function can occur without frank dyspareunia. Diminished genital sensation, lessened glandular secretions, less vasocongestion and decreased vaginal expansion
Abnormal vaginal bleeding after menopause
endometrial biopsy or D&C needed to rule out hyperplasia or CA if bleeding is more frequent or heavier bleeding persists after menopause. but some irregular vaginal bleeding is expected.
