Lecture 8 - Menopause Flashcards
What is menopause?
The permanent cessation of menstruation due to the loss of ovarian follicular activity
How is natural menopause diagnosed?
12months of consecutive amenorrhea where there’s no other obvious pathological or physiological cause
What is perimenopause/climacteric?
Where ovarian function starts to decline before menopause
What is early menopause?
When menopause occurs well below the average age of natural menopause (under 45)
What is premature menopause?
Cessation of menstruation due to depopulation of ovarian follicles before age 40
Its also called premature ovarian failure
What is physiological menopause?
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
What is pathological menopause?
When there’s gradual Oreo abrupt cessation of menstruation before 40 yrs old
What are the 4 phases of menopause?
Pre-menopause (cycle pretty normal but menopausal symptoms)
Perimenopause (changes start to happen to cycle before menopause)
Menopause (12months since last period)
Post menopause
What are the hormonal changes in pre-menopause?
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
Why are there changes to the cycle in the perimenopausal stage?
There’s less follicles left to ovulate so they produce less hormones
Follicular phase shortens
Or ovulation early or absent
What is post menopause?
Time after which a woman has experience 12 consecutive months of amenorrhea
As number of primordial follicles decreases production of what hormone decreases?
What affect does this have on other hormones?
Oestrogen production decreases
This means FSH and LH rises since the low oestrogen levels cant inhibiit the production of FSH and LH
How does the quantity and quality of oocytes change as women age?
What is the concern with this?
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
What is the cause of menopause?
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)
Who do you not use an FSH test on to diagnose menopause?
People using combined oestrogen and progesterone contraception or high0dose progesterone
How can you diagnose premature ovarian insufficiency?
Menopausal symptoms and elevated FSH levels on 2 blood samples taken 4-6 weeks apart
What are some early menopausal symptoms due to lack of oestrogen?
Hot flushes
Sweating
Insomnia
Menstrual irregularity
Psychological symptoms (anxiety and depression)
What are some intermediate and late stage symptoms of menopausa due to lack of oestrogen?
Osteoporosis
Atherosclerosis
Coronary heart disease
Cardiovascular disease
Alzheimer’s disease
What are some symptoms of menopause?
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
What causes the vasomotor symptoms in menopause?
How can you treat it?
The pulsation release of GnRH leads to the vasomotor symptoms
Giving oestrogen or progesterone will relieve symptoms
What can happen to menstrual bleeding due to menstruation?
Intermenstrual bleeding (spotting)
Menorrhagia
What causes the menorrhagia or mid cycle bleeds during the menopause?
Endometrium continues to thicken (hyperplasia) since theres no corpus luteum producing progesterone to stop the oestrogen production leading to continuos endometrium thickening
What appearance changes happen with menopause?
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
What are some menopausal effects on the GI and urinary systems?
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
What affects does lack of oestrogen have on the genitals?
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
What breast changes occur with menopause?
Low oestrogen decreases fat and tissue in breast and the connective tissue loses elasticity in the breasts causing sagging
What bone changes occur with meno pause?
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
Why is HRT considered in young post menopausal women?
Reduce risk of osteoporotic fractures
Why are post menopausal women more likely to develop coronary heart disease?
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
What are some lifestyle changes that can be done to help with menopause?
Regular exercise
Sleep hygiene
Light weight clothing
Avoid triggers like spicy food, caffeine smoking and alchol
What HRT can be used to help treat vasomotor or mood disorders caused by menopause?
Oral or transdermal HRT
Combined oestrogen and progesterone pill if woman has uterus
If no uterus give oestrogen
In a woman with a uterus, why would you give the combined oestrogen and progesterone pill?
The oestrogen is what treats the symptoms
However oestrogen causes the proliferation of the endometrium
So we give progesterone to prevent this over proliferation
What HRT treatments do you give someone with urogenital symptoms?
Low dose vaginal oestrogen first line
What are the benefits of HRT?
Reduced vasomotor symptoms
Improvement in mood changes
Improvement of urogenital symptoms
Reduction in oesteoporosis risk
Lower risk of colorectal cancer
Improves quality of life
What are the risk of HRT?
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
What are the advantages of oral HRT?
Cheap and effective
What is the advantage of using a transdermal patch for HRT instead of oral?
Reduced risk of Venous Thrombo Embolism
Whate is the advantage of using a Mirena Intrauterine System for HRT?
Its a progesterone coil so it also acts as a contraceptive
