Menopause Flashcards
Definition of menopause
The permanent cessation of menstruation that results from loss of ovarian follicular activity
- average age 51 years
- natural menopause considered to happen after 12 consecutive months of amenorrhoea, for which no other obvious cause is present
Define the climacteric
Phase encompassing the transition from the reproductive state to the non-reproductive state
The menopause itself thus is a specific event that occurs during the climacteric, just as the menarche is a specific event that happens during puberty
The symptoms are brought on by a drop in progesterone and oestrogen levels
Define premature ovarian insufficiency
A loss of normal function of the ovaries before the age of 40
- ovarian failure means sub-optimal amounts of oestrogen is produced, or eggs aren’t released regularly
- subfertility is a common result
Different from premature menopause because women with POI, can have periods for several years, and sometimes can become pregnanct
HPO-axis changes during menopause
Ovarian failure occurs, causing a drop in oestrogen production, therefore decreasing the negative feedback loop to the hypothalamus and pituitary.
- increased levels of FSH and LH are seen
- diagnostic of menopause
Causes of menopause and associated risk factors
Normal
Premature ovarian insufficiency
- primary (X-chromosome deletion 46XO, FSH receptor gene polymorphism, enzyme deficiencies and autoimmune disease)
- secondary (hysterectomy without oopherectomy, radio/chemotherapy, surgical menopause and infection)
Smoking
Primary ovarian insufficiency
Diagnostic criteria for menopause in women >45 years
Women who have not had a period for 12 consecutive months and are not using hormonal contraception
Menopause is based on symptoms in women without a uterus
Diagnostic criteria for menopause in women <45 years
Women who have menopausal symptoms, including a change in their menstrual cycle for 4 consecutive months + FSH increased (>30IU/L on 2 samples, 6 weeks apart)
Can’t interpret results if on COCP or high dose progesterone
Effect of menopause on vasomotor symptoms
Hot flushes Night sweats Palpitations Headaches Dizziness - most commonly reported symptoms during (peri)menopause - median duration of 7 years Palpitations
Effect of menopause on the pelvic floor
Effect - decreased blood supply - decreased tone - increased relaxation Consequence - uterovaginal prolapse
Effect of menopause on the vagina
Effect - vaginal epithelium becomes thinner and less rugose - intermediate cells are replaced by superficial cells - secretions diminish Consequences - atrophic vaginitis - dryness - painful sex/sexual dysfunction - relationship breakdown - general discomfort - trauma and bleeding
Effect of menopause the urinary tract
Effect - urethral mucosa atrophies Consequence - atrophic bladder - increased frequency - dysuria - incontinence - recurrent UTIs
Effect of menopause on the uterus, ovaries and uterine tubes
Ovaries and uterine tubes become atrophic
The muscle in the uterus become fibrous tissue
- fibroids in the uterus become smaller
Effect of menopause on the external genitalia
The external genitalia becomes atrophic and loses fat
Effect of menopause on mood and sleep
Depression Irritability Anxiety Memory Sleep disturbance Mood swings Poor concentration Decreased libido - due to mood/atrophic vaginitis
Effect of menopause on bone health + factors relating to early fracture
Factors contributing to an early presentation of osteoporosis related fractures - smoking - low BMI - long episodes of amenorrhoea - early age of menopause - FH of osteoporosis - systemic disease (e.g. renal) - drug usage e.g. steroids/chemotherapy Use FRAX risk assessment tool
