Menopausa

Question 1

What does it mean climacteric?

Answer 1

Climacteric: it is a stage of life That places women between 45 and 55 years, During Which
Verifies the progressive loss of reproductive capacity exhaustion heritage follicular
(Follicular atresia: However, the ovary may be still present in Certain proportion of follicles,
However, to the primitive stages or primary), accompanied by a progressive insensitivity
ovary to gonadotropins

Question 2

What does it mean menopause?

Answer 2

Menopause is the ***permanent cessation(nutraukimas) of menstrual flow***, peak and a clear sign of the ***decline
endocrine production***, with general effects of trophic character, metabolic and sexual.
The main feature of menopause is, Therefore, **ovarian failure** That determines not only an *inability reproductive* (for the non-ovulation), but anche a series of symptoms referable to
deficit hormonal (estrogen, progesterone but anche). ​

Question 3

In Additions to the time of menopause, are Considered:

Answer 3

• Premenopausal: is the period before the last menstrual period, accompanied by changes features
• Post-menopause is the last menstrual period Following the period (after age 65 does not speaks more of post-menopausal, but aging, And These changes are Attributable purely geriatric)
• artificial menopause: can be induced by radio- or chemotherapy or Surgery

Question 4

Considerations about menopause

Answer 4

• age of menopause
• duration of premenopausal period
• To define a menopause need to be gone a year since the last menstruation

Question 5

Average age of menopause?

Answer 5

50-52 years: the age of menopause is extended with improved living conditions. Therefore, In These conditions, you not only have a late menopause (accompanied Often by an early menarche), but, for the new social habits, the number of children, and Therefore anovulatory periods, is Considerably decreased. Therefore, the number of ovulations fatto che context is increased At Largely, as well as the average concentration of estrogen exposure
in this period, thus Resulting in increased At an incidence of estrogen-related conditions,: such as
endometriosis and ovarian and endometrial

Question 6

Duration of premenopausal

Answer 6

Duration of premenopausal: varies widely. In fact, some women in this period lasts
several years and is presented with the whole procession of symptoms That will be Analyzed later; in the other,
Instead, the condition, until the time of the last menstrual period, is normo-ovulatory and normo-
menstrual

Question 7

Hormonal changes (premenopausal)

Answer 7

• decreased secretion of inhibin (–> Increasing the production of FSH)
• While FSH Increases, there are still near normal levels of estrogen, progesterone and LH.
• esmė: hiperestrogeninė - hipoprogestageninė būklė
• Increases estrogen (hyperestrogenism related -> irregular menstruation; rases the risk of
  hyperplasia, endometrial polyps or cancer,
  as well as uterine leiomyomas and breast tumors
• However, the production of estrogen soon Becomes insufficient and only rarely determines the LH peak, and then ovulation. The cycles become more frequently anovulatory.
• Should be treated with progesterone to make bring the balance estrogen / progesterone).

In These cases premenopausal, can be determined two Circumstances:

• amenorrhea: begin to appear long periods (even 6-7 months) anovulatory.
• menstrual Irregularities: polimenorrea or menometrorrhagia: are associated with a high risk anemia

Question 8

Hormonal changes: post-menopausal

Answer 8

• there are no longer menstruating Because estrogen is too low.
• However, the reduced production of estrogen determines the absence of the feedback pituitary negative, with increased At release of FSH. Which is increased At (> 30 pg / mL), and estradiol, Which is decreased At (<25 pg / mL), is decisive (condition hypergonadotropic hypogonadism).
• Increase production extraovarica (adrenal, subcutaneous fat and perivisceral) of estrone

Question 9

Symptoms of neurodegenerative diseases

Answer 9

• Hot flashes: have a sudden feeling of extreme heat, with increased At vasodilation, and are accompanied by:
- Sweating
- Chills (drebulys)
• Sleep disorders, mood (irritability, depression), attention and memory
• Palpitations
• Fatigue
• Headache
• Paresthesias
• Dizziness (svaigulys)

Question 10

Symptoms (neurodegenerative diseases): when and why?

Answer 10

Usually occur in premenopausal, are indexed According Kupperman (for each disorder is Given
a score from 1 to 3 and Becomes the sum). Their pathogenesis would be Attributable, rather than a
decrease in estrogen, the abrupt change in concentration of estrogen (high> low> high).
In fact, in post-menopause, a when estrogen levels have stabilized, the symptomatology
autonomic regresses

Question 11

Menopausal disorders: short and medium terms

Answer 11

In the short term: neurodegenerative diseases
• In the medium term (6):

1. amenorrhea: Remember That, in the event of amenorrhea, to understand the adequacy levels estrogenic do the test to progesterone (in addition pcs, you do an ultrasound check: if adequate estrogen levels, the endometrium is, unlike what happens in the case of Low levels of estrogen, yet well Represented). Progesterone Has, in fact, the capacity to induce menstruation in women with adequate levels of estrogen, then: If the woman mestrua: estrogen levels Has still good and is not in menopause If the woman does not mestrua: or is in menopause (with hepatic estrogen) or in pregnancy
2. atrophy of the skin, mucous membranes and respiratory glandular breast
3. atrophy of the genitourinary: OCCURS on the embryogenesis of this stretch (third the distal end of the vagina, urethra, bladder trigone), Which makes it sensitive to estrogens, and manifested by:

***Vaginal dryness: causes difficulty During intercourse (dyspareunia surface: that is, at the moment of penetration; endometriosis, However, was deep)
***Increased incidence of vaginitis is Caused by:
• Inadequate vaginal tropism
• Changes in vaginal flora
***Most of the periurethral tissue laxity: exacerbation of pathologies dysfunctional or anatomical, leading to urgent (even with nocturia) and Urinary incontinence (typical of post-menopausal)

4. weight gain
5. arthralgias
6. decreased At libido

Question 12

Menopausal disorders: long term

Answer 12

increased At cardiovascular risk: the decrease in estrogen levels change is the lipid is the vascular system:

Changes in the lipid
• Increased LDL
• Decreased HDL
• Increased lipoprotein A
Changes of the vascular system
• Increased vasoconstriction
• Increased deposition of atheromatous plaque
• Decreased production of prostacyclin
• Increase of the factors procaoagulativi

Osteoporosis is Caused by a loss of bone, age-dependent Generally, During The bone remodeling, in cui intrinsic and extrinsic factors they act, Which, exaggerating the process, Determining an increased At resorption. One of these factors is the
decrease in estrogen
neoplastic risk: especially cancers of the endometrium, breast and ovarian
(Important methods of screening

Question 13

Hormone replacement therapy

Answer 13

It is based on the assumption That, Given That menopausal disorders result from a reduction of the
estrogen, administration of estrogen is protective against These disorders. However,
improperly administering estrogen in menopause, Has disproportionately increased At the
Number of carcinomas of the endometrium. Then, it is Introduced theadditional use of progesterone: However, the risk of endometrial cancer was not Significantly reduced. Later, it was shown That
Also the risk of breast cancer increases.
So, currently, in TOS is indicato only for short-term disorders (ie Those neurodegenerative) or
early menopause.
However, administering estrogen** (etilenestradiolo, 17-β-estradiol, estradiol valerate) and **progestin
oral, transdermal, vaginal or intravascular.
The association between estrogen and progestin can be either sequential (estrogens and progestins mimic
the cyclical physiological) or continuous type: the principle is the same as the contraceptive pill, but the results are very minor.
Tibolone, However, That is a Particular estrogen has no effects on the endometrium and does not require Therefore
the association of a progestin.
Also, the use of androgens is Particularly suitable to combat decreased At libido.
Finally, a note on phytoestrogens: These Are food supplements, contained Mainly in soybeans,
That have estrogenic-like properties