Menopause

Question 1

Define menopause

Answer 1

No menstrual periods for 12 consecutive months when no other biological or physiological cause can be identified.

Question 2

Define climacteric

Answer 2

Physiologic period in a women’s life during which there is regression of ovarian function.

Question 3

Define menopausal transition

Answer 3

Time between onset of irregular menses and permanent cessation menstruation; average duration is about 4 years

Question 4

Define early menopause

Answer 4

Menopause that occurs well below the average of natural menopause (under 45)

Question 5

Define premature menopause

Answer 5

Cessation of menstruation due to depletion of ovarian follicles before age of 40 also called premature ovarian failure.

Question 6

Define surgical menopause

Answer 6

Permanent cessation of menstruation after bilateral oophorectomy

Question 7

When it is considered not possible for a women to conceive?

Answer 7

After 12 months of no menstruation

Question 8

When does menopause occur?

Answer 8

45-55 avg 50

Results in infrequent ovulation. Decreased menstrual function and eventually cessation of menstruation.

Question 9

What are the four phases of menopause?

Answer 9

Pre-menopausal
Peri-menopausal (transition menopause)
Menopause
Post menopausal

Question 10

What is pre-menopausal?

Answer 10

Time prior to menopause

Changes in menstrual cycle start to occur,

Typiilcally age from about 40 - Follicular phase shortens, ovulation early or absent.

Less oestrogen secreted

LH and FSH rise - FSH more (reduced negative feedback)

Reduced fertility

The women would not necessary notice anything different.

Question 11

What is peri menopause?

Answer 11

Transition phase

Characterised by physiological changes associated with the end of reproductive capacity.

Terminating with the completion of menopause.

Also called climacteric.

Question 12

What is menopause?

Answer 12

Permeant cessation of menstruation caused by ovarian follicular development failure.

Question 13

What is post-menopause?

Answer 13

It is defined formally as the time after which a women has experienced 12 consecutive months of amenorrhea.

Question 14

How do oocyte quality and quantity change with age?

Answer 14

Oocyte quality and quantity decline as you age, this mean you are less likely to get pregnant the older you are.

Question 15

How do hormone levels change during menopause?

Answer 15

Rise in FSH and LH (FSH rises more)

Decrease in oestrogen and inhibin.

Question 16

What are the symptoms of menopause?

Answer 16

Early:
Hot flushes 
Sweating
Insomnia
Menstrual irregularity
Psychological symptoms - anger, depression, anxiety 

Intermediate:
Virginal atrophy
Dyspareunia
Skin atrophy
Urge-stress incontinence 

Late: 
Osteoporosis 
Atherosclerosis
CHD
CVD
Alzheimer’s disease

Question 17

What is a hot flush?

Answer 17

A sudden, transient sensation of warmth to intense heat over face, chest, neck and head; followed sometime by profuse perforation. It lasts between few seconds to several minutes.

Symptoms include chills, nausea, anxiety, head or chest pressure, feelings of suffocation, inability to concentrate.

Frequency: rare to recurrent every few minutes; more at night or during stress.

Question 18

What is dysfunctional uterine bleeding?

Answer 18

Spotting between cycles

Extremely heavy bleeding

Mid-cycle bleeding

Longer, shorter or unpredictable lengths of time between periods and of periods

Question 19

What is the effect of continued oestrogen on dysfunctional uterine bleeding?

Answer 19

Causes the endometrium to keep thickening. (if lots = hyperplasia)

Lead to a late menstrual period followed by irregular bleeding and spotting.

There is no corpus lute so no progesterone which leads to increased risk of carcinoma due to unopposed oestrogen

Question 20

What psychological changes occur during pregnancy?

Answer 20

Frequent headache

Irritability

Fate

Depression and insomnia

Diminished sex drive (could be due to vaginal dryness)

Loss of sleep due to night sweats

Question 21

What changes do we see in the ovary?

Answer 21

Smaller ovaries (atrophic)

Decreased oestrogen production

Produced small amount of androgen during reproductive life.

Important as aromatase converts androgens to oestrogen in ovary and adipose tissue.

After menopause, the substantially increased gonadotropin levels maintain ovarian androgen secretion despite substantial oestrogen demise

Question 22

How does your appearance change during menopause?

Answer 22

Skin: Loses its elasticity and becomes thin and fine. Due to 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. More deposition of far around hits, waist and buttocks.

Hair: Hair becomes dry and coarse after menopause. There may be hair loss due to the decreasing level of oestrogen

Voice: Deeper due to thickening of vocal cords

Question 23

How does the digestive and Urinary systems change?

Answer 23

Motor activity of the entire digestive tract is diminished after menopause - the intestines tend to be sluggish, resulting in constipation.

As the oestrogen level decreases, the tissue lining the urethra and bladder become dryer, thinner and less elastic.

• Changes in bladder loss of pelvic tone
• Urinary incontinence
• Increase frequency of urination and UTIs

Question 24

What changes occur in the uterus?

Answer 24

uterus becomes small and fibrotic due to atrophy of the muscles after menopause.

• Regression of endometrium
• Shrinkage of myometrium

The cervix becomes smaller and appears to flush with vagina. In older women, the cervix may be impossible to identify separately from the vagina.

• Thinning of cervix
• Vaginal ruggae lost

Question 25

What changes occur to the external genitalia?

Answer 25

Vulva - fat in the labia majora and the Mons pubic decreases and pubic hair becomes sparse

Breast - in thin built women the breast becomes flat and shrivelled and in heavy built women they remain flabby and pendulous.

Question 26

How does bone change during menopause?

Answer 26

Increased calcium loss from the bone is increased in the first 5 years after the onset of menopause, resulting in loss of bone density.

The calcium moves out of bones, leaving them weak and liable fracture at the smallest stress.

Reduced oestrogen enhances osteoclast ability to absorb bone.

Oesteoporosis risk is greater,

Question 27

What changes occur in the cardiovascular system?

Answer 27

Cardiovascular disease should be an elderly women’s major concern.

• Changes in metabolism
• Increased cholesterol in the blood -Hyperlipidemia

Gradual rise in risk of heart disease and stroke after menopause

Question 28

What non-hormonal treatments are there for menopause?

Answer 28

Dress in light layers avoid caffeine, alcohol and spicy foods - decrease hot flushes and night sweats

Reduce dietary fat and regular exercise to combat weight gain during menopause.

Question 29

What are the hormonal treatments for menopause?

Answer 29

HRT - can be administered orally (pill), vaginally (cream) or transdermally (patch).

Minimise symptoms as replaces oestrogen lost during menopause. -Can improve well-being and limit osteoporosis.

But, it is not advised as it increases the risk of cardiovascular complications.