Menopause Flashcards
CLIMACTERIC – transition from ________ to ___________ state.
reproductive to non-reproductive
reproductive to non-reproductive
MENOPAUSE –______________________ of menstruation. Usually diagnosed after _________ of __________.
permanent ceasation
1 year of amenorrhoea
The average age at menopause in Nigeria is ___________ years.
In western women, the average age at menopause is ______ years.
49 ± 1.5
52
Menopause occuring before the age of ________ is termed “PREMATURE MENOPAUSE”.
45
Pathophysiology
Human ovary contains an outer ———- and an inner _________.
Both contains ________ cells which provide support for the ovary, produce _______ (basically ________) and some are recruited to become _______ cells that surround follicles in the cortex.
cortex ; medulla; stroma
steroids; androgens
theca
For every follicle which matures to ovulation, up to ________ follicles fail and become atretic while probably only about 400 out of the ________ follicles present at puberty mature to ovulation.
1000
400,000
With ageing, the ________ count diminishes and finally the ________.
follicle
ovaries fail
The first endocrine change as menopause approaches is a fall in the ____________ level. The function of this hormone is to ——————. Hence ______________.
Oestradiol level subsequently falls and become insufficient to bring about _____________ and _________, thus menopause ensues.
inhibin
inhibit FSH production
FSH level rises.
endometrial proliferation and menstruation
The ovaries produce four principal hormones:
List them
. It also secretes the peptide hormone “ ________ ”
oestradiol, progesterone and the androgens (testosterone and androstenedione)
Inhibin
Ovarian cycle and menstrual function are controlled by ______ and _____ release of which is regulated by ______.
FSH and LH,
GnRH
In premenopausal state, majority of the circulating plasma oestradiol is produced by the ________ lining the developing follicles, by conversion of ____________ and _________, and catalysed by the __________ enzyme, stimulated by ______.
granulosa cells
androstenedione and testosterone
aromatase; FSH
Oestradiol is also converted in the theca cells from androgens, which are produce from _________ under stimulation of ____.
cholesterol
LH
Primary causes – may be due to chromosomal abnormalities such as variants of turner’s syndrome and autoimmune disorders such as hypothyroidism, Addison’s disease.
Non-physiological causes of menopause
Secondary causes – can follow surgeries such as __________________________ for malignancies or severe ____________, radiotherapy, chemotherapy, use of drugs such as ________________ in treating conditions like uterine fibroids and endometriosis, and infections such as tuberculosis, mumps.
hysterectomy with bilateral salpingo-oophorectomy
endometriosis; GnRH analogues
Effect of menopause
VASOMOTOR SYMPTOMS
__________
————-
____________
Hot flushes.
Night sweats.
Palpitations.
Effects of menopause
UROGENITAL
______________
Recurrent _____________.
Sensory urgency.
Urogenital _____________.
_____________
_________________
Vulval and vaginal dryness.
urinary tract infections
prolapse
Dyspareunia.
Decreased sexual desire.
Effects of menopause
MUSCULOSKELETAL
____________
____________________________
Arthritis.
Osteoporosis with resultant pathological fractures.
Effects of menopause
CARDIOVASCULAR
Cardiovascular diseases such as ____________
OTHERS
_________,_________, and ___________ .
Hair changes.
cardiac ischaemia.
Skin wrinkling, dryness and itchiness
Management of menopause
Alternative therapy – use of ___________________ , herbal preparations like ___________,__________ ,_______________ ,_____________ .
phyto-oestrogens
St. John’s Wort, acupuncture, magnetism, reflexology
Management of menopause
Medical treatments – NON-HORMONAL
α-adrenergic e.g. clonodine.
β-blockers e.g. propanolol.
Selective serotonin reuptake inhibitors (SSRI) e.g. venlafaxine, fluoxetine, Gabapentin.
Selective Estrogen Receptor Modulator (SERM) e.g. Raloxifene.
Tibolone – has oestrogenic, progesteronic and androgenic properties. If given for 1 year, will effectively reduce climacteric symptoms and reduce bone loss.
🌚🌚
HRT – can be ___________,_________________ or ____________ . This helps in reducing ________, reduce ________ symptoms and improves ______________.
oestrogen alone, oestrogen + progesterone combined, progesterone alone
hot flushes; urogenital; osteoporosis
