End Of Repoductive Life Female1 Flashcards
What’s the definition of menopause?
Permanent cessation of menstruation caused by failure of ovarian follicular development and estradiol production
No mensural periods for 12 consecutive months and no other biological or physiological cause can be identified
When’s the normal age of menopause? What’s pathological menopause?
Normal decline in ovarian function due to ageing begins between 45-55yrs
Begins with infrequent ovulation and eventually cessation
Pathological menopause - gradual or abrupt cessation of menstruation before 40yrs, idiopathically occurs 5%
What are the four categories of the menopausal phase? What happens to Levels of hormones
Pre-menopause ( typically from age 40, slightly less oestrogen, LH/ FSH May rise, reduced fertility, cycles relatively unchanged)
Peri-menopausal/ climacteric (transition phase, follicular phase shortens, ovulation early or absent)
Menopause
Post-menopause (after 12 consecutive months amenorrhea, very low oestrogen)
When does the decline in oocytes begin?
Around 24 weeks gestation (after conception)
Accelerated atresia of oocytes around 36yrs
During reproductive life roughly how many primordial follicles grow into mature follicles and ovulate?
400
What causes menopause?
Ovaries are totally depleted of follicles and no gonadotrophins can force them to work (primary ovarian failure) -> cessation of menstruated cycles -> oestrogen levels fall -> LH and particularly FSH rise dramatically (bc no Inhibin either)
What are the consequences of oestrogen deficiency and so the symptoms of menopause?
Early menopause (40-50)
Hot flushes (bvs peripheries vasodilation)
Sweating
Insomnia
Menstrual irregularity
Psychological symptoms
Weight increase (more deposition of fat around hips/ waist/ buttocks)
Intermediate menopause (50-65)
Vagina atrophy (oestrogen retains tone)
Dyspareunia
Skin atrophy (loses elasticity, loss elastin and collagen)
Urge-stress incontinence (loss of pelvic tone, increased UTis)
Late (65+)
Osteoporosis (oestrogen inhibits bone resorption)
Hair dry and coarse
Voice deeper (thickening vocal cords)
Constipation (motor activity digestive tract diminished)
Atherosclerosis (increased circulating lipid level)
Coronary heart disease
Cardiovascular disease
Alzheimer’s disease
Explain what the hot flush is e.g. symptoms, description, duration and frequency
Sudeden, transient sensation of warmth to intense heat over face/chest/ neck/ head followed sometimes by profuse perspiration
Chills, nausea, anxiety, feelings suffocation, inability to concentrate
Few seconds- several minutes
Rare to recurrent every few minutes more at night/ when stressed
Explain why women often get dysfunctional uterine bleeding pre-menopause
E.g. spotting between cycles, menorrhagia, change in frequency and regularity
Caused by changes in oestrogen concentration
Causes the endometrium to keep thickening (hyperplasia) leads to late menstrual period, no corpus luteum so no progesterone
Increased risk of carcinoma (unopposed oestrogen) aromatisation of testosterone
What’s the difference between abnormal and dysfunctional uterine bleeding?
AUB- many causes, some benign
When AUB is related to changes in hormone levels that directly effect the mensuration cycle = DUB
DUB also called ‘not yet classified’ in PALM COEIN causes of AUB
Explain why there is still some oestrogen secretion after menopause?
Atrophy of ovaries due so decreased oestrogen production but produce small amount of androgen during reproductive life
Aromastase converts androgens to oestrogens in ovary and adipose tissue
After menopause the increased gonadotropin levels maintain ovarian androgen secretion despite substantial oestrogen demise
What changes to the genital organs can you see post-menopause?
Vagina atrophy
Uterus becomes small and fibrotic due to atrophy of muscles - regression of endometrium, shrinkage of myometrium
Cervix becomes smaller, flush with vagina
Older women cervix may be impossible to identify
Vagina rugae lost
Urogenital atrophy (senile vaginitis)
Fat in labia majora and mons pubis decreases
Pubic hair sparse
Thin women- boobs flat and shrivelled
Heavy women- boobs flabby and pendulous
Explain the changes in bone during and post menopause
Calcium loss increased in first 5 years after inset of menopause -> loss of bone density 2.5% each year
Reduced oestrogen enhances osteoclasts activity to absorb bone -> osteoporosis -> easily fracture
Why is coronary artery disease the biggest killer of post-menopausal women?
Lack of oestrogen and progesterone -> changes in metabolism -> increased cholesterol in blood and hyperlipidemia, gradual rise in the risk of heart disease and stroke post-menopause
Increased insulin resistance -> diabetes
Blood pressure increases
Weight gain
Carbohydrate tolerance decreases
What are some non-hormonal treatments to help with menopause?
Dressing light layers
Avoiding caffeine, alcohol, spicy foods
Reduce dietary fat
Regular exercise
