menopause Flashcards
amenorrhoea
one or more missed menstrual periods
what is menopause
permanent cessation of menstruation due to loss of ovarian follicular function
is retrospective diagnosis - only classed as menopause when no periods for at least a year
what is perimenopause
, generally defined as a period of changing ovarian function that precedes the menopause by 2-8 years
what is premature ovarian failure
menopause under the age of 40
symptoms of menopause
- hot flushes &disturbed sleep due to declining oestrogen
- reduced cycle length due to reduced follicular phase
- amenorrhoea
- dry vagina
- impaired fertility
physiological changes in menopausal women
- Reduced follicle count – none or few at menopause
- Reduced granulosa cell number
- Reduced granulosa cell function (reduced efficiency in producing the hormones)
- Increased chromosomal abnormality of oocyte
why do menopausal women get amennorrhoea
lack of the corpus luteum
menstruation needs built up endometrium but decline in progesterone =shed endometrium due to prostaglandins causing necrosis.
But if there is a thin endometrium and it isn’t vascularised yet, it won’t shed as no progesterone and low oestrogen
in embryology, make about 10m eggs.
at what two stages does this rapidly decline in number
just before birth
and then prepuberty and then a more rapid drop at menopausal age
why does follicular depletion occur
- Follicular depletion:
Increased follicular death (apoptosis)
Ovarian environment: e.g. smoking reduces age at menopause by mean of 2 years and shorter transition - Accelerated follicular loss- Anti-Mϋllerian Hormone declines, follicle stimulating hormone increases, increased follicular recruitment
At the start of the menopausal transition, why will most women will have a shortened cycle
decline in inhibin B production from the granulosa cells (that usually inhibits FSH)
leads to elevated FSH in the follicular phase, causing earlier elevated oestrogen and earlier LH surge
later on in menopausal transition why may women have delayed or absent ovulation
- elevated FSH stimulates oestrogen release from granulosa
- impaired granulosa cell function .’. oestrogen does not rise ENOUGH to cause LH surge .’. ovulation =delayed/absent
- = heavier periods bc longer oestrogen stimulation of endometrium causing proliferation.
dominant follicle isn’t recruited so the woman will have consistent heavy bleeding (no progesterone)
why is there heavy periods in late menopause
onger oestrogen stimulation of endometrium .’. proliferates more.
dominant follicle isn’t recruited so the woman will have consistent heavy bleeding (no progesterone).
why is FSH higher than normal in menopause
relative FSH insensitivity due to fewer FSH receptors on the granulosa cells, consequently fewer follicles will get recruited and as there is no inhibin B? FSH rises
how do AMH levels change with menopause
decline is first sign of declining ovarian function
how do inhibin B levels change with menopause
starts to decline ~2 before final menstrual period
how do FSH levels change with menopause
variable with each cycle but overall increases towards menopause
how do LH levels change with menopause
increases later on in the menopausal transition
how do oestrogen levels change with menopause
starts to fall closer to the menopause and around this time the hot flushes will be experienced
how do proesterone levels change with menopause
no progesterone produced after menopause
why is there a decline in oocyte function and development in menopause
impaired production of growth factors/survival factors from granulosa cells
.’. decline in function of the oocyte.
abnormal oocyte =impaired follicle recruitment .’.can=anovulatory cycles and an increased miscarriage rate
decreased ability to repair DNA, there is increased aneuploidy
Which hormone decreases first during a woman’s reproductive life
AMH
Which hormone is no longer produced after the menopause
progesterone
Which symptom is not associated with the menopause
Urinary incontinence
primary treatment option for treating hot flushes
Oestrogen in HRT
risk of HRT
breast cancer
thrombosis
risks are very low for short term use of HRT
what is the best treatment for hot flushes in a 53 year old woman who has had a thrombotic stroke
Sertraline (SSRI), we don’t want to give HRT as she has a higher risk of thrombosis
long term risks of using HRT
Increased risk of breast cancer
Increased risk of pulmonary embolus and venous thrombosis and stroke (thrombotic disease)
long term benefits of using hrt
effective at treating hot flushes
- Decreased risk of hip fracture
- Decreased risk of colorectal cancer
chronic management of menopausal women
- > Treat hot flushes
- > Address the smoking
- > Increase physical activity, monitor BMI and nutrition
- > Cardiovascular risk management
- > Do mammography and cervical cytology
