Menopause

Question 1

Why do we have menopause?

Answer 1

• Blessings of modern life: we live longer versus most animals who reproduce whole life
• Senescence: Occurs so that aging women do not undergo hazard of childbirth
• Group selection: Protects human gene pool from age related chromosomal abnormalities
• Good mother/grandmother theory: Pause from reproduction to provide extended maternal care of offspring

Question 2

When is it referred as menopause?

Answer 2

The end of the last menstrual bleed due to running out of follicles to atresia and ovulation

Question 3

Follicle loss over life

Answer 3

Fetal 7 million
At birth 1-2 million
Decline with puberty 400000
Menopause >1000

Question 4

The popcorn hypothesis

Answer 4

While the quantity of the follicles declines, the quality also decreases

Question 5

What factors influence the timing of menopause?

Answer 5

In well nourished populations, independent of racial backgrounds
Poorly nourished- early
Smoke- early (mostly primordial demise)
Mothers and daughters early onset

Question 6

What are the phases of menopause?

Answer 6

Pre menopause: 40-46, regular menstrual bleeds
Menopausal transition: 46-50/52. Irregular cycles occuring
Post menopause: After the LMP

Perimenopause: Start of irregular cycles to a few years after the LMP (OS). When symptoms start to manifest
Ovarian senescence: Ovary stops working, a few years post LMP

Question 7

The longer the cycle length the less likely it is to be ____

Answer 7

Ovulatory

Question 8

Events during perimenopause

Answer 8

Follicle level drops below critical level of about 25000
Inhibin B levels drop
Resulting in increased FSH
This accelerates follicular loss by a shortened follicular phase and increased early follicular estrogen

Question 9

How does increased FSH affect follicular reserve?

Answer 9

Depletes it faster due to more recruitment, coincides with increased chance of non-identical twins

Question 10

More features of perimenopause

Answer 10

Irregular cycles, including anovulatory
Increased FSH, LH too but not to the same extent
Oestrogens high early perimenopause, but lower in late perimenopause
A decrease in androgen in later perimenopause also
Ovulation can occur though and contraception is difficult

Question 11

Post menopause

Answer 11

Can be said woman over 45, amenorrhea for 12 months, likely post menopausal
Some follicles may be left, but unresponsive
By about a year post LMP, ovary ceases hormone production (senscence)
Oestrogen concentarion daily (post menopausal) is less than 1/10 than what she would produce in the preovulatory phase.
Circulating oestradiol very low, little variation

Question 12

What oestrogen do post menopausal women rely on?

Answer 12

Oesteone, produced by aromatisation (of androstenedione) of adipose tissue. Predominant oestrogen, despite some being converted to oestradiol. Is a weak oestrogen (1/10 effect)

Question 13

Perimenopausal symptoms

Answer 13

Vasomotor: As a result of oestradiol> Hot flushes, night sweats often with palpitations weakness etc
GU symptoms: Vaginal dryness, atrophic changes, etc
Reduction in uterus size
Reduction in breast density: Post M women easier to screen for breast cancer
Bone metabolism: Increased catabolism, osteoporosis
Behavioural/Psychological: Depression, loss of libido,anxiety

Question 14

Hormone replacement therapy

Answer 14

Infusion of oestrogens and progesterone to reduce symptoms. However linked with uterine and breats cancer so used for women with moderate to severe symptoms, and lowest dose for shortest time