Menopause Flashcards
what is menopause?
Permanent cessation of menstruation.
The result of exhaustion of ovarian follicle supply.
No follicles = no estradiol
what is perimenopause?
Onset of menstrual irregularity and vasomotor sx.
Avg age of onset = 47yo
Lasts about 4 yrs
End of perimenopause can be defined as -
most common definition: 1yr of amenorrhea within the typical age range
alternate definition: 1yr of amenorrhea AND end of perimenopausal sx
timing of menopause (average age in US)
avg age is 51yo
factors that determine menopause timing
most important factor is genetics**
environment also plays a role (smoking, never pregnant, low SES – can all cause earlier menopause)
Primary ovarian insufficiency is defined as -
menopause before age 40 confirmed by hormone levels
ALWAYS CONSIDERED PATHOLOGIC
etiologies of primary ovarian insufficiency?
- idiopathic (most cases)
- genetic (X chromosome defects)
- autoimmune disorders
- chemo/radiation
workup for primary ovarian insufficiency includes -
- check FSH
- if FSH is high and pt is < 40yo, then do karyotype and autoimmune disorder screening
decreasing ovarian follicle supply
- highest number of ovarian follicles is before birth
- decreases to 1 million at birth
- sharp decreases begins at about age 37 (25k left)
- less follicles left because more are recruited each cycle
decreasing ovarian follicle supply leads to decreasing _____________
granulosa cell function
first granulosa cell product to decrease in supply is ______
inhibin
inhibin provides ____________ to the pituitary to decrease ____ production
negative feedback; decrease FSH production
Decreased inhibin leads to increased _______
FSH and LH
As ___ levels increase, ovarian follicular recruitment in each cycle increases, leading to faster ____________.
FSH; faster follicular atresia
