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Reproduction Week 1 > Lecture 10: Ovarian Aging and Menopause, Physiology and Pathophysiology > Flashcards

Lecture 10: Ovarian Aging and Menopause, Physiology and Pathophysiology Flashcards

1
Q

What does impact of ovarian aging lead to?

A 
Menopause
Female infertility
Morbidity associated with age-appropriate and premature menopause
	CVD
	Osteoporosis
	Urogenital atrophy
	Quality of Life
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2
Q

How will most programmed oocytes die in a female?

A

They will undergo atresia

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3
Q

What are the clinical correlates of loss of follicles?

A
  1. reduced odds of pregnancy
  2. fewer follicles grow per cycle as woman ages
  3. menstrual cycle irregularity becomes more common
    The rate of follicular atresia is not fixed and becomes more rapid approximately 10-15 years prior to menopause
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4
Q

What is menopause?

A 
The point when permanent cessation of menstruation occurs following loss ovarian activity
No period for 12 months straight
Retrospective diagnosis
Perimenopause/menopausal transition
	-menstrual irregularity, symptoms
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5
Q

What is the time of menopause?

A

50-52 years (mean/median)

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6
Q

What is perimenopausal/menopausal transition?

A

Median age = 47.5 yo

Menstrual irregularity, symptoms

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7
Q

What are the factors related to age of onset of menopause?

A
  1. smoking hastens onset of menopause by 1.5 years
  2. familial component
  3. possible dietary habits (vegetarians earlier than meat eaters)
  4. alcohol consumption might be associated with later menopause
  5. no definitive correlation with menarche age, oral contraceptive, race, SES, parity
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8
Q

What are the health risk related to menopause?

A
  1. CVD
    • total and LDL cholesterol levels are lower in premenopausal women than in men
    • levels gradually increase with age and after menopause
    • metabolic syndrome increases during perimenopause and postmenopause
  2. osteoporosis
  3. Hot flash
    • heat inside the body that leads to sweat
  4. urogenital atrophy
  5. musculoskeletal symptoms
  6. disordered sleep
  7. mood
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9
Q

How do you treat menopausal symptoms?

A
  1. Hormone replacement therapy (estrogen+progestin or estrogen only)
  2. Selective Serotonin Reuptake Inhibitors (SSRIs)
  3. Antihypertensives
  4. Behavioral
    • diet
    • weight loss
    • smoking cessation
    • exercise
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10
Q

What is premature ovarian insufficiency?

A
  1. Cessation of ovarian function at age 40 yo or less
  2. incidence 1% per year
  3. Biochemical diagnosis
    • elevated gonadotropins (LH, FSH) in the menopausal range need to be documented on at least two separate occasions one month apart with low estradiol
  4. The risks are as follows:
    • osteoporosis
    • diminished quality of life
    • CVD
    • infertility
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11
Q

Why are elevated gonadotropins (LH, FSH) in females diagnostic for premature ovarian insufficiency?

A

Because High FSH and LH means there is no ESTROGEN being produced
Estrogen should be inhibiting the gonadotropes

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12
Q

What are the etiology/risk factors of premature ovarian insufficiency?

A
  1. Genetic/cytogenetic abnormalities
  2. Autoimminue causes
  3. metabolic disorders
  4. iatrogenic/exposures
    • chemotherapy
    • radiation therapy
  5. smoking
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13
Q

What is one common chromosomal etiology of premature ovarian failure?

A

Turner’s Syndrome

One X chromosome and that’s it

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14
Q

What does Turner’s Syndrome predispose you to ovary wise? Lol

A

Premature ovarian failure

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15
Q

What are the clinical features of turners syndrome?

A
  1. premature ovarian failure and delayed puberty
    • rapid atresia of oocytes
  2. Short stature
  3. Renal anomalies
  4. Cardiovascular abnormalities
  5. Associated autoimmune disorders
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16
Q

What is the point of the X chromosome?

A

Required to be active in the ovary to ensure normal development and maintenance of oocyte number
Needed for follicle maintenance

17
Q

What can chemotherapy and radiation do to the ovary?

A
  1. Chemotherapy damages primordial follicles
    Cyclophosphamide (alkylating agents) are particularly damaging to follicles)
  2. Radiation therapy to the pelvis is most damaging
    -scatter from treatment to other areas can also affect ovary
18
Q

What are the benefits and risks of giving hormone replacement to premature ovarian failure patients?

A 
Benefits
	-quality of life
	-osteoporosis prevention
	-prevention of CVD
Risks
	-depends on etiology of ovarian failure
	-risk of DVT
19
Q

Why may premature ovarian failure patients be at risk for DVT?

A

Due to hormone replacement therapy

20
Q

What are effective methods for fertility preservation?

A
  1. IVF and embryo cryopreservation
  2. Oocyte cryopreservation
  3. Oophoropexy
21
Q

What is oophoropexy?

A

Surgical fixation or suspension of an ovary

22
Q

Is Premature ovarian failure is just an acceleration of the normal process?

A

No

Several known pathologic causes have been determined some of the subtle underpinnings still to be determined

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