Menopause Flashcards
What is menopausal transition?
- regular periods to irregular periods to when periods stop
- AKA perimenopausal
What is menopause?
- stopping menstruatin bc of loss of ovarian follicular function
- no period for 12 months (amenorrhea)
What is premature ovarian failure?
- premature menopause
- before age of 40
What are the symptoms of menopausal transition?
- hot flushes
- reduced cycle length
- irregular periods
- atrophic vagina post menopause
- impaired fertility leading up to menopause
- mood symptoms
- urinary complaints
- sleep disturbance
- vasomotor symptoms
What is atrophic vagina?
- vaginal thinning, drying and inflammation of the walls bc of less oestrogen
- painful sex
What is a follicle?
-oocyte surrounded by granulosa and theca cells
What happens to the number of follicles as we age?
- Fetus= 7 million
- birth= 1 million
- Puberty= 400 000
- menopause= 140
- post menopause= hardly any - maybe like 1
Why is menstruation stopping not a reason for menopause?
- average woman has 444 cycles in her life
- so only 444 eggs lost through cycle
- so at menopause there are still between 1 and 140 eggs left, so periods stopping is not the reason for menopause
Why do the eggs die as we age?
- apoptosis
- breakdown
- smoking causes menopause 2 years early
What are the effects of granulosa cells?
- produce AMH
- secrete inhibin B
If you have less granulosa cells because of follicle depletion, what happens?
- less AMH
- less Inhibin B
- less Inhibin A
What is the role of AMH?
men= regress mullerian duct women= inhibit excess FSH
What happens if AMH reduced?
- excess FSH
- this means more (than required) follicular recruitment
- more follicle loss
What does Inhibin B do?
Inhibits FSH production
What happens if you have low Inhibin B?
- more FSH
- more follicular recruitment
- more follicle loss
- so as woman gets nearer to menopause age, she has more menstrual cycles that have no ovulation in them
Where is Inhibin A produced?
in the ovaries
What does Inhibin A do?
Inhibits FSH production
What happens if Inhibin A is reduced?
More FSH
What happens if there is excess FSH?
- FSH receptors on the follicles become less sensitive to FSH (due to extremely high levels of FSH) - due to loss of FSH receptors and their sensitivity, there is an impairment in recruitment of follicles and selection of a dominant follicle (ie the follicles do not get selected)
What else happens as a result of granulosa cells decline?
woman has impaired secretion of growth
factors, signalling pathways, survival factors, oestrogen, and progesterone
What is the reason for shortened cycle length?
- there is decline in inhibin B
- high FSH levels
- so follicles are recruited early
- oestrogen goes up earlier
- LH surge happens earlier
- so follicular phase is shorter
- so shorter cycle
What causes delayed or absent periods?
- granulosa cells are dysfunctioning
- oestrogen levels cant reach high enough to flip negative feedback to positive feedback
- no LH surge
- no ovulation
What causes heavier periods?
- less Inhibin B
- high FSH
- oestrogen levels increase earlier than in normal cycle
- oestrogen remains high for long time
- endometrium of uterus hyperproliferates
- endometrium outgrows blood supply
- prolonged bleeding (2-3 weeks)
What can you provide patients with to help them with bleeding?
- progesterone
What causes hot flushes?
- less granulosa cells
- less oestrogen
- disturb serotonin levels
- resets thermoregulatory nucleus in the brain stem
- heat loss
- brain thinks body is hotter than it acc is- sweating
What happens to the hormone levels?
- 10 years before menopause, AMH declines
- 2 years before menopause, inhibin B levels decline
- FSH levels are variable, but generally increase towards menopause
- LH increases later in menopause
- Oestrogen levels fall, but this is very close to the menopause
- Adrenal and ovarian androgen levels decline with age (from about 20 years old)
What happens to progesterone after menopause?
- no progesterone after menopause
- bc woman is not ovulating
There is no progesterone production after menopause
•
this is because the woman is no longer ovul
ating, and thus there is no corpus
luteum
•
the corpus luteum is the only source of progesterone in the bod
