Menopause Flashcards
the permanenet cessation of menstration is due to..
failure of ovarian follicular development in the presence of ADEQUATE gonadotropin stimulation
climacteric
physiologic period in which there is regression of ovarian fxn
peramture ovarian failure
cessation of menstruation due to depletion of ovarian follicles less than 40 yo
average age of menopause
51.4 range 48-55
average for perimenopause
47.5 y/o average length about 4 yrs
premature menopause
genetic abnormalities on long and short arm of X chormosome
RF for early menopause
Surgical causation FHx early cigarette smoking blindness chromosome defect precocious puberty left handedness
RF for later age menopause
obesity, higher SES
___ number of follicles at birth and at menopause
1 million follicles at birth and 1000 left by menopause
what is most follicular loss due to ?
atresia not ovulation
when does atresia rate accelerate?
age 37
atresia definition
closure of tubal structure, death of unfertilized follicles?
6 changes to ovaries in perimenopause
- ovaries shrink in size
- estradiol secretion amount decreases
- number of follicles decrease substantially
- production of inhibin lowers
- remaining follicels respond poorly to high FSH and LH
- erratic ovulation results in menstrual cycle irregularity
where is inhibin produced
gonads, pituitary glands, placenta, corpus luteum, other organs
FSH stimulates secretion of __ from granulosa cells of ovarian follicles
inhibin
inhibin does what
suppresses FSH
if inhibin secretion gets lower with each cycle…___ gets higher
FSH secretion
t/f elevations of FSH at the start of a cycle are predictive of perimenopause and of the fertility of the remaining ova
true
at age 45 risk of spontaneous miscarriage is__
up to 50%
what is day 3 FSH testing
a routine way to measure ovarian reserve
if FSH high on day 3 cycle, indicates ovarian reserve is low = low egg quality / reserve
normal day 3 FSH level is..
less than 9
diminished reserve when FSH on day 3 is over
11
what occurs in perimenopause?
- shortening of menstrual cycle
2. shorting of follicular phase w/ lower # of follicles recruited per cycle
w/ menopause ovary is no longer able to…
respond to pituitary gonadotropins low estrogen and progesterone perduction
what 4 things decrease with menopause
- circulating estrogen
- ratio of estrogen to androgen
- sex hormone binding globulin secretion
- E2 to E1 ratio
what hormone is increased in menopause
increased peripheral aromatization of DHEA to estrone
what hormone level stays same in menopause
circulating bioavailable testosterone
what cells make estrogen
theca and granulosa cells of ovaries
as these atrophy.. get less estrogen secretion = high FSH and LH
e1 estrone
predominant e in menopause
from aromatization of androstenedione in fatty tissue
less potent than E2
E2: estradiol
predominant E of women after puberty but before menopause
E3: estriol
placental E only seen in large amounts w/ preg
least potent of all E
from fetal adrenal gland in form of DHEA sulfate
placenta turns that into estriol
postmenopausal women main E
E1 made in periphery
cause of hot flash
unknown ..related to estrogen, LH and NEpi
what is gonadal theory of hot flashes?
hot flash is caused by removal of sex hormones after the body has been exposed to them for a period of time..a dynamic loss of sex hormones
3 arguments to back up gonodal theory
no estrogen = hot flash
orchiectomy = hot flash in many men
hot flashes go away if hormone replaced
yet what is exact MOA?
pituitary theory of hot flashses
extreme rise in FSH and LH cause them
2 arguments for pit theory of hot flash
- seen pulse or surge of LH prior to hot flash
2. even if surge does not happen, seem to happen near an LH peak
evidence against pit thoery
ppl with chronically high FSH and LH (turners / kallmans) do not have hot flashes
hypothalamic theory behind hot flashes
inhibiting hypothalamic catecholamines (NE) causes hot flashes
when E levels drop so do the drop of NE receptors
when E is low.. those remaining receptors may be stimulated abnormally
CVD risks with menopause
6-10 yrs after CAD rates equal men and women
cholesterol increase 1-2 yr after menopause (less HDL higher TG and LDL)
genital changes in menopause
- atrophy of vaginal epithelium
- decent of uterus due to collagen in uterosacral ligament
- urologic .. decrease in urethral closure pressure
- atrophic urethritis
atrophic cystitis
atrophic urethritis sx
urgency, frequency, dysuria, suprapubic pain without UTI
atrophic cystitis sx
urge incontinence, frequency, dysuria, nocturia
3 most common fx in postmenopausal women
vertebral, distal radius, neck of femur
in what circumstance can a premenopausal women be exposed to unopposed estrogen?
if she doesn’t have a uterus
estrogen and progestin HRT tx risks
increased: MI, stroke, blood clots, breast CA
lower: colorectal CA, decreased risk fx
ex of combo hrt tx
Premarin with Provera
tx vaginal atrophy
topical vaginal estrogen
ADR: breast pain, N = some systemic absorption
