Menopause Flashcards
Natural Menopause
permanent cessation of menstrual periods, determined RETROSPECTIVELY, after a woman has experienced 12 months of amenorrhea with out any pathological or physiological cause
Median age of menopause
51.4
Ovarian follicular depletion results in this during menopause
HYPOestrogenemia and HIGH follicle stimulating hormone (FSH) concentrations
Primary ovarian insufficiency
menopause before age 40, also called premature ovarian failure- considered to be abnormal
Perimenopause - when and what are the s/s
after the reproductive years but before menopause usually 4 years before the last menstrual period – characterized by irregular menstrual cycles, endocrine changes and hot flashes, sleep disturbances, mood symptoms, vaginal dryness, and changes in lipids and bone loss
Most common menopausal symptom
hot flashes seen in up to 80 percent of women
Late reproductive years s/s
serum inhibin B decreases, FSH increases slightly, estradiol is preserved, luteal phase progesterone declines as fertility potential declines. follicular phase before ovulation SHORTENS. Typically in their 40s.
Perimenopause s/s and age of onset
ovarian follicular depletions leads to a change in intermentrual interval (lengthened) cycle usually 25-35 days between but now 40-50 days. and a change in bleeding pattern, and hormonal s/s. Usually age 47. FSH > 25 but will fluctuate
Late transition
one to three years before the final menstrual period, lengthened intermentrual interval with skipped cycles, amenorrhea episodes, and an increased in anovulatory cycles
the more irregular the cycle the more dramatic fluctuation in
FSH and estradiol, may be high FSH with menopause but then a return to normal premenopausal range
Increase risk of what during the year leading to the final menstrual period
accelerated bone loss, cardiovascular risk. With 3 months of amenorrhea can expect their FMP within the next 4 years.
Hallmark s/s of perimenopause and menopause
hot flash, also a/w new onset depression, vaginal dryness and sleep disturbances
Hot flashes sensation
heat on the upper chest and face, rapidly becoming generalized 2-4 mins with profuse sweating, palpitations, anxiety. can have one per hour each day, very common at night. untreated stop within 4-5 years of onset.
Sleep disturbances
arousal from sleep from hot flashes
Anxiety/depression
can lead to sleep disturbances as well. can also have restless leg or sleep apnea.
Depression risk
significant increase risk of new onset depression during menopausal transition. perimenopausal 2.5x more likely than premenopause – estrogen therapy to treat
Vaginal dryness
epithelium of vaginal walls is estrogen dependent and deficiency leads to thinning and dryness – vaginal atrophy, on exam vagina will appear pale. can be itchy and women often experience dysparenia
Sexual function
estrogen deficiency leads to decrease in blood flow to the vagina and vulva, leads to decrease vaginal lubrication and sexual dysfunction, vagina may lose elasticity and become shorter – responds to estrogen therapy, also cervix can atrophy and become flush with the top of the vaginal vault
Cognitive changes
memory loss, difficulty concentrating, estrogen beneficial in cognitive function
caution
not totally protected from pregnancy until amenorrhea for >12 mos or CONSISTENTLY elevated FSH >30
not all hot flashes are from estrogen deficiency- other differentials?
pheochromocytoma (worst it could be)
leukemia’s
thyroid malfunction
psychosocial symptoms
first measurable sign of reproductive ageing
FSH elevation >10 IU/L in early follicular stage (days 2- 5 of the mentrual cycle)
most follicular loss results from what?
atresia, NOT ovulation
climacteric
phase in a women’s aging process marking the transition from reproductive to non reproductive states, is a process, not a point in time
vasomotor symptoms
aka hot flashes, hallmark sx of perimenopause/ climacteric, worse at night, interrupts sleep. can continue even in post- menopause
making the definitive diagnosis of menopause
no ONE test, woman has reached menopause when FSH are consistently >30 (caveat- levels often inconsistent for a temporary span of time)
if dx of menopause is not clear..
Rule out other DD
