Exam 3 - Menopause Andropause Flashcards
Age of Menopause and Life Expectancy
Increased dramatically
Life expectancy Used to 38, now 78 years of age
Technology, medicine, improved nutrition
2050 - expectancy expected to be 84 years
Occurs usually at 52 years of age
Early menopause is before 40 years
Osteoporosis increases
Stages of Reproductive Life
Takes 5 - 10 years to be thru perimenopause - first sign of
hormonal change - lose estrogen - ovaries dont make bioactive
anymore because you lose all your eggs - still able to get pregnant
- decrease in fertility - age 40 to 50
Menopause - cessation of child bearing years - menstrual cycle
stops - 12 months without menstrual cycle considered to be in
menopause
–
Birth
Menarche
Age 12 - 14
Perimenopause
Menopause
Age 50 -52
Postmenopause
Death
Changes Egg Cell Numbers over Life Cycle
Start with most before birth then declines
Menopause - no more eggs
Atrexia - losing eggs
Eggs become more sensitive to FSH and LH
Lose huge amount of eggs in perimenopause
Eggs disinergrate in ovaries
Born with around 1 million oocytes
Reproductive Cycle
Brain releases GnRH
which releases FSH and LH
which affects the ovaries to produce Estradiol and Progesterone
Which acts as negative feedback to GnRH
–
FSH matures egg, prepare uterus for implantation
of egg, acts on ovaries to produce estrogen
GRH acts on pituitary to release FSH and LH
Estrogen helps prepare uterus for implantation
eggs follicle becomes corpus luteum, increases lining of the uterus
Estradiol - active form of estrogen - most biologically active
Perimenopause / Menopause
Increased levels of GnRH FSH LH
lead to decreased levels of estradiol and progesterone
which positive feedbacks into GnRH to make more
-- Overall decrease in 17-Estradiol - decrease in progesterone Increase in GRH, Increse in FSH and LSH Higher brain hormones
Life Cycle Hormone Fluctuations
High estrogen and progesterone during teens years until it drops in perimenopause
–
Perimenopause - levels of estrogen and
progesterone decrease
Supplementing estrogen increases risk of breast cancer
Estrogen Deficiency
Before 52: Irregular menses
Hot flashes
Sleep disturbances
Vaginal dryness and tissue atrophy
After 52: Decreased skin thickness Redistribution of body fat / gain Increased LDL : HDL in blood Osteoporosis Heart Disease
–
Climacteric syndrome - estrogen decreasing
Irregular menstrual cycle
Hot flashes - direct effect of hormonal inflexions
Increase in core temperature - sweating, face
gets red, get very hot - seen in 70% of American women, 20% of
Japanese women - cause unknown - vessel dialation - usually
goes away after menopause, 10-30% have hot flashes after 70
years of age
Sleep disturbances - moodiness and irritability
Skin tissues becomes thinner
Redistribution: Body fat goes from hip to abdominal area (lack of
estrogen)
Hysterectomy would also go thru this if they remove the ovaries
Osteoporosis - 3% per year around (peri)menopause, loss will
slow
Postmenopause
Steroid Hormones
• Estrone
• Androgens (Testosterone)
–
Estrodiol is gone - no follicoles or eggs to make
estrogen
Estrone - makes estrogen compound, not as
biolocally active, maked from ovaries
Ovaries still secrete testosterone
Adrenal gland, ovaries, fat cells - make steroid hormones -
estrone and androgens
Treatment Menopausal Symptoms
Prescription Drugs
• Hormone Replacement
• Other Medications
Lifestyle Approaches
–
Replace hormones that you are losing
Hormone Replacement
Estrogen / Progesterone
Benefits
• reduce hot flashes
• decreases vaginal dryness
• decreases bone loss
Risks
• heart disease / stroke
• breast cancer
–
Women’s health initiative clinical trial - study effects of hormone
replacement therapy on women
Bone Loss in Menopause
Growth - More osteoblasts, less osteoclasts
Postmenopause - Fewer osteoblasts, more osteoclasts
Osteoblasts - lay down bone
Osteoclasts - take down bone
8% of bones remodeling at anytime
Takes 10 years to replace skeleton
Menopause - osteoblasts become less active,
osteoclasts increase. Bone density will decrease
Other Medications
Hot Flashes / Depression
–Low Dose Antidepressant
Low Bone Density (see Osteoporosis slides)
- -Biphosphonates
- -Hormonal agents
Low Dose Antidepressants decrease hot flashes
by ~60%
Side effect - weight gain
Biphosphonates - help retain bone
Also add progesterone or else increase in uterine cancer
Lifestyle Approaches to Menopause - Healthy Practices
Healthy Practices: Avoid smoking Avoid excessive alcohol Balance, adequate diet Maintain healthy weight Exercise regularly Practice stress reduction
–
Smoking can trigger early menopause
Exercise - weight bearing exercise, jogging, stress and strengthen the bones (not swimming)
Practice stress reduction - e.g. meditation.
Decrease hot flashes by 50%
Lifestyle Approaches to Menopause - Dietary Practices
Dietary Practices
Adequate Vitamin D / Calcium Low to moderate caffeine Avoid excessive alcohol Phytoestrogens - Soy isoflavanones - Flaxseed lignans • Herbs (inconclusive)
–
Vitamin D increases blood calcium, eat
calcium-rich foods
Caffeine can trigger hot flashes
Alcohol can make hot flashes worse
Phytoestrogens found in soy and flaxseeds - may reduce hot
flashes - estrogen-like compounds - results variable
Andropause
Gradual decline male hormones (testosterone)
- erectile dysfunction / decreased sex drive
- loss of muscle mass
- anxiety / irritability
- sleep disturbance
- loss bone density
- cardiovascular disease
–
Menopause - 5 years
Andropause - longer
Lose in 30s, by 50s may be having effects from
low testosterone
Usually occur at 40 - 55 years of age. Have ED
and decreased sex drive
Bind testosterone increases (liver makes), testosterone decreases
Hormone replacement therapy - getting testosterone
