Menopause

Question 1

What is menopause

Answer 1

• end of menstruation 
• Greek word ` mens ’ meaning
``monthly’’ and ` pausis ’ meaning
``cessation ‘’. 
• Menopause is a part of a women’s
natural ageing process 
• when her ovaries produce lower level
of the oestrogen and progesterone 
• when she is no longer able to
become pregnant.

Question 2

What is teh definition of menopause

Answer 2

• Menopause is the permanent cessation of
menstruation at the end of reproductive life due to loss of ovarian follicular activity
• Menopause is defined as the time when there has been no menstrual periods for 12 consecutive months and no other biological or physiological cause can be identified.

Question 3

What is physiological ad pathologicalmenpause

Answer 3

• Physiologic menopause:
– The normal decline in ovarian function due to ageing begins in most women between ages 45 and
55 on average 50 – result in infrequent ovulation, – decreased menstrual function and eventually cessation of menstruation.
• Pathologic menopause :
– The gradual or abrupt cessation of menstruation before 40 years occur idiopathically in about 5% of
women in USA.

Question 4

What are phases of menopause

Answer 4

• End of reproductive life • Menopausal phase : It is the end of reproductive life
– The age of menopause ranges between 45 – 55 years,
– average being 50 years

 • The menopause phase is usually broken down into four categories:-
– Pre-menopause
– Peri-menopausal (transition menopause)
– Menopause
– Post menopause

Question 5

What is pre menopause

Answer 5

Prior to menopause -
Typically age 40=, follicular phase shortens, ovulation early or absent
Less oestrogen
Fsh and lh levels rise - fsh rises more than Lh
(Reduced negative feedback)
Reduced fertility. But not infertile

Question 6

What is peri menopause

Answer 6

Characterised by the physiological changes associated with the end o reproduction
Tetminating with the completion of menopause
Also called climacteric

Question 7

What ismenopause

Answer 7

Permanent cessation of penstuation caused by the ovarian follicular development failure

Question 8

What is post menopause

Answer 8

Post-menopausal:
– It is defined formally as the time after which
a women has experienced 12 consecutive month of amenorrhea without period

Question 9

What si teh burning out of ovaries

Answer 9

• 100,000’s of ova degenerate
• Reproductive life ~400 of the primordial follicles grow into mature follicles and ovulate.
• ~45 years old only a few primordial follicles remain to be stimulated by FSH and LH
• The production of oestrogen by ovaries decreases as the number of primordial follicles approaches
zero
• When oestrogen production falls below a critical value the oestrogens can no longer inhibit production of gonadotrophins (FSH and LH)

Question 10

Describe oocyte quality wth age

Answer 10

Ss

Question 11

What is the cause of menopause

Answer 11

• Menopause occurs when the ovaries are totally
depleted of follicles and no amount of stimulation
from gonadotrophins can force them to work
• i.e primary ovarian failure
• Cessation of menstrual cycles
• Average age ~50, but variable
• No more follicles to develop
• Oestrogen levels fall dramatically
• FSH & LH levels rise, FSH dramatically
– No inhibin

Question 12

Summarise gonadotrophins in menopause

Answer 12

Ss

Question 13

What are consequences of oestrogen deficiency

Answer 13

Ss

Question 14

What are the effects n the vasomotor system

Answer 14

• Vascular changes
• Affect circa 80% to
some degree
• Transient rises in skin temperature & flushing
• Relieved by oestrogen treatment
The hot flush - increadiby hto feeling in head and neck - physiological rises, can be produce perspiration, ss

Question 15

Describe dysfunctional uterine bleeding

Answer 15

• Dysfunction uterine bleeding
– Spotting between cycles
– Extremely heavy bleeding
↓[Oestrogen]
– Mid-cycle bleeding
– Longer, shorter, or unpredictable lengths of
time between periods
– Longer, shorter, or unpredictable durations of periods
• continued oestrogen
– causes the endometrium to keep thickening
– leads to a late menstrual period followed by irregular bleeding and spotting.
– greater thickening called “hyperplasia,”
– No corpus luteum = no progesterone
– Increased risk of carcinoma (unopposed oestrogen)

Question 16

What are the psychological chanegs in menopause

Answer 16

• The psychological changes are mainly
manifested by
– frequent headache,
– irritability,
– fatigue,
– depression and insomnia .
– Although these are often said to be due to changes in the hormonal levels, they are more likely to be related to the loss of sleep due to night sweat.
– Diminished interest in sex may be due to emotional upset or may be secondary to painful intercourse due to a dry vagina.

Question 17

What are changes in the ovary

Answer 17

• The ovaries become smaller (atrophic)
– oestrogen production  ↓
– produced small amount of androgen
during reproductive life 
– Important as aromatase converts
androgens to oestrogens in ovary and
adipose tissue 
– after menopause the substantially increased gonadotropin levels maintain
ovarian androgen secretion despite
substantial oestrogen demise

Question 18

What are he changes in general appearance

Answer 18

• Skin :
– The skin loses its elasticity and becomes
thin and fine. This is due to the loss of elastin and collagen from the skin.
• Weight :
– weight increase is more likely to be the
result of irregular food habit due to mood swing . There is more deposition of fat around hips, waist and buttocks.
• Hair :
– Hair become dry and coarse after
menopause . There may hair loss due to the decreasing level of oestrogen.
• Voice :
– Voice become deeper due to thickening of
vocal cords.

Question 19

What are digestive an durinary chanegs

Answer 19

• Motor activity of the entire digestive tract is diminished after menopause.
– The intestine tend to be sluggish resulting in constipation.
• Urinary system: As the oestrogen level decreases after menopause, the tissue lining the urethra and the bladder become drier, thinner and less elastic .
– Changes in bladder loss of pelvic tone
– Urinary incontinence
– This can lead to increased frequency of passing urine as well as an increased tendency to develop UTI

Question 20

What are changes in the genital organs

Answer 20

of the muscles after the menopauses
• Regression of endometrium 
• Shrinkage of myometrium
• The cervix become smaller and appears to flush with vagina. In older women the cervix may be impossible to identify separately from vagina
– Thinning of cervix
– Vaginal rugae lost

Question 21

Whar ae changes in the external genitals and breasts

Answer 21

• Vulva
– The fat in the labia majora and the Mons pubis decreases and pubic hair become spare.
• Breast
– In thin built women the breast become flat and shrivelled
– In heavy built women they remain flabby and pendulous

Question 22

What are teh chanegs in bone

Answer 22

• Bone
• Calcium loss from the bone is increased in the first five years after the onset of menopause, resulting in a loss of bone density .
• The calcium moves out of the bones, leaving them weak and liable to fracture at the smallest stress.
– Bone mass reduces by 2.5% per year
for several years
– Reduced oestrogen enhances osteoclast ability to absorb bone
– Osteoporosis
• Much greater in some than others
– Major reason for fractures in later life
– Can be limited by oestrogen therapy

Question 23

What are changes in the cvs

Answer 23

• Cardiovascular disease should be an elderly woman’s major concern
– The lack of oestrogen and progesterone causes many changes in women’s physiology that affect their health and well-being .
– changes in the metabolism of the
body.
– Increased cholesterol level in the blood: Hyperlipidemia or an increase in the level of cholesterol and lipids in the blood is common.
• gradual rise in the risk of heart disease and stroke after menopause.

Question 24

What are non hormonal treatments

Answer 24

• There are variety of menopausal treatments both natural and medical that can alleviate the symptom of menopause:
– Dressing in light layers can alleviate hot flashes and night sweats; avoiding caffeine , alcohol and spicy foods can also minimize these symptoms.
– Menopause and weight gain tend to go together due to life style changes than to the hormonal changes .
– Reducing dietary fat intake and regular exercise help to combat weight gain during menopause.

Question 25

Describe hrt treatment

Answer 25

• is indicated in menopausal women to overcome the short-term and long- term consequences of oestrogen deficiency.
• HRT can be administered orally
– ( in pill form),
– vaginally( as a cream),
– Transdermally (in patch form)
• because it replaces female hormones produced by the ovaries, hormone replacement therapy minimize menopause symptoms. It can be used before, during and after menopause.
• Can improve well-being
• Can limit osteoporosis
– Current advice no longer recommended for first line protection
• Not advised for cardioprotection