L15 - Hormone Abnormalities 2 Flashcards
1. Define normal menopause and the hormonal changes that occur and relate these to the clinical changes seen 2. Define both premature menopause and premature ovarian failure 3. Describe the common causes of premature ovarian failure (POF) and how it is diagnosed 4. Describe how the above hormonal changes lead to the long term complications of POF 5. Discuss possible causes, investigation and treatment options that are available. 6. Briefly discuss functional problems such as cervical ectopy
Define menopause?
12 months since last menstruation.
Patient not pregnant and is not taking hormones which would induce amenorrhoea.
Briefly summarise changes in hormones during menopause?
- As proportion of anovulatory menstrual cycles increases,
- progesterone production will decrease.
- Pituitary production of FSH & LH will increase
- due to diminished negative feedback loop from oestrogen / inhibin
What is the clinical diagnosis of menopause?
Serum levels of FSH over 30 and irregular / absent periods.
What is anti-mullerian hormone?
- Glycoprotein product
- of granulosa cells enveloping each egg.
- Good marker of follicular reserve.
- Only present in ovary until menopause
What are some symptoms of menopause?
- Vaginal bleeding
- Hot flush
- Genitourinary atrophy
- urethra and bladder are oestrogen dependent
- and will undergo gradual atrophy after menopause. - Osteoporosis
- Bone resorption of osteoclasts in accelerated
Describe basis of hormone therapy for menopausal women?
- Oestrogen supplementation.
- Given with progestogens
- to protect from endometrial hyperplasia that would result if just oestrogen was given.
What are some risks of hormonal treatment?
- Endometrial carcinoma
- Venous thromboembolic disease
Describe the onset of puberty?
> 8 years
GnRH pulses increase in amplitude and frequency such that FSH and LH release increases.
This stimulates oestrogen release from the ovary.
Menorrhagia
Heavy bleeding
AKA HMB - heavy menstrual bleeding, usually > 80mls
What may be some causes of heavy menstrual bleeding?
- Subtle abnormalities of endometrial haemostasis
- Uterine fibroids (30% women)
- Uterine polyps (10%)
What is endometrial haemostasis?
- Cessation of menstrual bleeding
- achieved by endometrial haemostasis
- via
1. platelet aggregation
2. fibrin deposition
3. thrombus formation.
Describe what examination of a female patient may show?
- Irregular enlargement of uterus suggests fibroids.
- Tenderness without enlargement suggests adenomyosis
Adenomyosis
Inner lining of uterus breaks through myometrium.
State the stages of menopause
- Perimenopause - first features, vasomotor symptoms and menstrual irregularity
- Post menopause - 12 months after spontaneous amenorrhoea
Why are periods in menopausal women shorter?
> 45 y/o
1. Inhibin B from granulosa cells falls
- causing a rise in FSH.
- Increased FSH stimulates increased oestradiol from remaining follicles.
- Oestradiol released more rapidly, resulting in shorter menstrual cycles.