Lecture 8 - Menopause

Question 1

What is menopause?

Answer 1

The permanent cessation of menstruation due to the loss of ovarian follicular activity

Question 2

How is natural menopause diagnosed?

Answer 2

12months of consecutive amenorrhea where there’s no other obvious pathological or physiological cause

Question 3

What is perimenopause/climacteric?

Answer 3

Where ovarian function starts to decline before menopause

Question 4

What is early menopause?

Answer 4

When menopause occurs well below the average age of natural menopause (under 45)

Question 5

What is premature menopause?

Answer 5

Cessation of menstruation due to depopulation of ovarian follicles before age 40

Its also called premature ovarian failure

Question 6

What is physiological menopause?

Answer 6

The normal decline in ovarian function due to ageing normally between ages 45 and 55

Leads to infrequent ovulation, decreased menstrual function and eventually cessation of menstruation

Question 7

What is pathological menopause?

Answer 7

When there’s gradual Oreo abrupt cessation of menstruation before 40 yrs old

Question 8

What are the 4 phases of menopause?

Answer 8

Pre-menopause (cycle pretty normal but menopausal symptoms)

Perimenopause (changes start to happen to cycle before menopause)

Menopause (12months since last period)

Post menopause

Question 9

What are the hormonal changes in pre-menopause?

Answer 9

Less oestrogen made and less inhibin is made

LH and FSH levels start to rise (FSH more than LH rises)

Reduced fertility but can still have kids

But cycle still normal

Question 10

Why are there changes to the cycle in the perimenopausal stage?

Answer 10

There’s less follicles left to ovulate so they produce less hormones

Follicular phase shortens
Or ovulation early or absent

Question 11

What is post menopause?

Answer 11

Time after which a woman has experience 12 consecutive months of amenorrhea

Question 12

As number of primordial follicles decreases production of what hormone decreases?

What affect does this have on other hormones?

Answer 12

Oestrogen production decreases

This means FSH and LH rises since the low oestrogen levels cant inhibiit the production of FSH and LH

Question 13

How does the quantity and quality of oocytes change as women age?

What is the concern with this?

Answer 13

Decreased quantity and quality

Meaning that the older the woman is when she gets peregnant the more likely the child is likely to have genetic defects

Question 14

What is the cause of menopause?

Answer 14

When ovaries are totally depleted they stop making oestrogen and inhibin

This leads to no inhibition of FSH and LH production so these levels rise (FSH levels rise more than LH since inhibin is what inhibits FSH production)

Question 15

Who do you not use an FSH test on to diagnose menopause?

Answer 15

People using combined oestrogen and progesterone contraception or high0dose progesterone

Question 16

How can you diagnose premature ovarian insufficiency?

Answer 16

Menopausal symptoms and elevated FSH levels on 2 blood samples taken 4-6 weeks apart

Question 17

What are some early menopausal symptoms due to lack of oestrogen?

Answer 17

Hot flushes
Sweating
Insomnia
Menstrual irregularity
Psychological symptoms (anxiety and depression)

Question 18

What are some intermediate and late stage symptoms of menopausa due to lack of oestrogen?

Answer 18

Osteoporosis

Atherosclerosis
Coronary heart disease
Cardiovascular disease

Alzheimer’s disease

Question 19

What are some symptoms of menopause?

Answer 19

Vasomotor symptoms (hot flushes/night sweats)

Changes to the menstrual pattern

Cognitive impairment and mood disorders

Urogenital symptoms

Altered sexual function

Sleep disturbance

Skin and hair changes

Question 20

What causes the vasomotor symptoms in menopause?

How can you treat it?

Answer 20

The pulsation release of GnRH leads to the vasomotor symptoms

Giving oestrogen or progesterone will relieve symptoms

Question 21

What can happen to menstrual bleeding due to menstruation?

Answer 21

Intermenstrual bleeding (spotting)

Menorrhagia

Question 22

What causes the menorrhagia or mid cycle bleeds during the menopause?

Answer 22

Endometrium continues to thicken (hyperplasia) since theres no corpus luteum producing progesterone to stop the oestrogen production leading to continuos endometrium thickening

Question 23

What appearance changes happen with menopause?

Answer 23

Skin (loses elasticity due to lack of elastin and collagen)

Weight (weight gain due to irregular food habits due to mood changes)

Hair (dry and coarse hair, also hair loss due to decreasing I oestrogen)

Voice becomes deeper due to thickening of vocal cords

Question 24

What are some menopausal effects on the GI and urinary systems?

Answer 24

Constipation (reduced motor activity of entire digestive tracts)

Tissue lining urethra and bladder are drier, thinner and less elastic:
-loss oof pelvic tone
-urinary incontinence
-reduced elasticity of bladder (nocturia, dysuria and urgency to urinate)
-inc susceptibility to UTIs

Question 25

What affects does lack of oestrogen have on the genitals?

Answer 25

Thinning of vaginal skin (can cause painful sex = dyspareunia and bleeding)

Lack of glycogen causing less acidic vagina which increases infection risk

Give oestrogen creams

Question 26

What breast changes occur with menopause?

Answer 26

Low oestrogen decreases fat and tissue in breast and the connective tissue loses elasticity in the breasts causing sagging

Question 27

What bone changes occur with meno pause?

Answer 27

Bone mass reduces since lack of oestrogen leads to enhanced osteoclast activity (they resorb bone)

Can lead to osteoporosis and inc risk of fragility fractures

Question 28

Why is HRT considered in young post menopausal women?

Answer 28

Reduce risk of osteoporotic fractures

Question 29

Why are post menopausal women more likely to develop coronary heart disease?

Answer 29

Thought oestrogen has a positive affect on lipid metabolism preventing levels of LDL and VLDL getting too high

Post menopause:
LDL, VLDL and lipoproteins high

HDL low

Insulin resistance increase and inc body weight

Question 30

What are some lifestyle changes that can be done to help with menopause?

Answer 30

Regular exercise
Sleep hygiene
Light weight clothing
Avoid triggers like spicy food, caffeine smoking and alchol

Question 31

What HRT can be used to help treat vasomotor or mood disorders caused by menopause?

Answer 31

Oral or transdermal HRT

Combined oestrogen and progesterone pill if woman has uterus

If no uterus give oestrogen

Question 32

In a woman with a uterus, why would you give the combined oestrogen and progesterone pill?

Answer 32

The oestrogen is what treats the symptoms

However oestrogen causes the proliferation of the endometrium
So we give progesterone to prevent this over proliferation

Question 33

What HRT treatments do you give someone with urogenital symptoms?

Answer 33

Low dose vaginal oestrogen first line

Question 34

What are the benefits of HRT?

Answer 34

Reduced vasomotor symptoms

Improvement in mood changes

Improvement of urogenital symptoms

Reduction in oesteoporosis risk

Lower risk of colorectal cancer

Improves quality of life

Question 35

What are the risk of HRT?

Answer 35

VTE (risk with oral HRT not transdermal/patch)

Breast cancer (oestrogen and progesterone pills , but not oestrogen pills)

CHD and stroke

Endometrial cancer (oestrogen only HRT increases risk of endometrial cancer in women with a uterus (progesterone reduces risk

Question 36

What are the advantages of oral HRT?

Answer 36

Cheap and effective

Question 37

What is the advantage of using a transdermal patch for HRT instead of oral?

Answer 37

Reduced risk of Venous Thrombo Embolism

Question 38

Whate is the advantage of using a Mirena Intrauterine System for HRT?

Answer 38

Its a progesterone coil so it also acts as a contraceptive