Menopause Flashcards
Definition of menopause
The final menstrual period, can only be diagnosed after 12 consecutive months of amenorrhoea while not on any hormonal treatment
Definition of perimenopause
The symptoms experienced in the years preceding menopause while ovarian activity fluctuates
Definition of surgical menopause
Menopause occurring when functional ovaries are surgically removed
Definition of premature menopause
Menopause occurring before the age of 45
Average age of menopause in Western society
52 years (no change in last 150 years)
Iatrogenic causes of menopause
Surgical removal of functioning ovaries
Radiotherapy
Chemotherapy
Temporarily during GnRH analogue treatment
Causes of primary premature ovarian failure
Chromosome abnormalities (Turner's, Fragile X) Autoimmune: hypothyroidism, Addison's, Myasthenia Gravis Enzyme: galactosaemia, 17a-hydroxylase deficiency
Causes of secondary premature ovarian failure
Surgical menopause
Chemo or radiotherapy
Infectiosn (TB, mumps, malaria, varicella)
Endocrine changes in menopause
First change: fall in inhibin production (responsible for FSH production inhibition) - increased FSH
Reduces oestradiol levels- eventually insufficient to stimulate endometrial proliferation = menopause
Further decline in subsequent years - effects on all oestrogen-responsive tissues
GU effects of menopause
Vaginal atrophy - trauma, dryness, spontaneous bleeding, infection
Distal urethra + trigone bladder - similar atrophy - urinary symptoms without infection
Pelvic floor dysfunction - weakening of supporting ligaments and tissues - increased prolapse and stress incontinence
Osteoporosis mechanism in menopause
oestrogen = anti-resorptive agent on trabecular bone
Thus, dec. oestrogen - inc. bone resorption - dec. bone density
Oestrogen effects on CVS
inc. LDL, dec. HDL
direct effect on vessel wall - vasodilation via NO
thus increased risk of CVD after menopause
Short-term symptoms of menopause (0-5y)
Vasomotor: hot flushes, night sweats
Psychological: labile mood, anxiety, tearfulness
Cognitive: loss of concentration, poor memory
Joint aches and pains
Dry, itchy skin
Hair changes
Reduced libido
Intermediate effects of menopause (3-10 years)
vaginal dryness, soreness Dyspareunia Sensory urgency Urinary frequency Recurrent UTIs Urogenital prolapse
Long term effects of menopause (over 10y)
Osteoporosis
Cardiovascular disease
Dementia