Menopause and Premature Ovarian Failure Flashcards
Menopause
Last menstrual period - 12 months without menstruation with no other cause.
Perimenopause
The years leading up to menopause, associated with fluctuating levels of oestrogen due to declining ovarian function.
Vasomotor symptoms of menopause
Hot flushes
Night sweats
Palpitations
Insomnia
Psychological symptoms of menopause
Irritability
Depression
Sexual symptoms of menopause
Decreased libido
Dyspareunia
Dyspareunia
Painful intercourse
Urogenital symptoms of menopause
Atrophic Vaginitis
Vaginal dryness
Urge incontinence / frequency
Urethral symptoms
What are the long term circulation problems of menopause?
Cardiovascular disease
Cerebrovascular disease
What are the long term skeletal problems of menopause?
Osteoporosis
Hip-fracture
Vertebral fracture
Why is there a decrease in oestrogen in menopause?
There is a reduced number of ovarian follicles.
less follicles = less oestrogen
How are LH and FSH levels affected in menopause?
To try and increase levels of oestrogen there is an increase in GnRH and thus increased LH and FSH.
In premenopausal women oestradiol is produced by what cells of the developing follicle?
Granulosa cells produce oestradiol
Premature menopause
A condition in which menstrual periods stop before age 40. This can cause fertility problems and symptoms of menopause.
Premature ovarian failure
A condition in which a woman ovaries stop functioning normally before she is 40.
Why do androgenic features begin to develop in menopause?
Decreased oestrogen results in increased LH. LH cannot stimulate follicles to produce oestrogen anymore and so androgen’s are produced instead.
A 40yr old woman experiencing shorter menstrual cycles is likely what?
Peri-menopausal
Where is there an increase in oestradiol levels in peri-menopausal women?
45yrs there is a decrease in inhibin levels resulting in an increase in FSH levels.
This increased FSH stimulates release of oestradiol from the remaining follicles.
HRT
Hormone replacement therapy
What is the main use of providing HRT?
HRT is normally provided to help protect bone mineralisation.
> lessens the symptoms of menopause.
What are the risks of HRT?
Increased risk of breast cancer, endometrial cancer, venous thromboembolism and gallbladder disease.
How is premature ovarian failure clinically defined?
4 months of amenorrhoea
FSH levels >30iu/ml
What are the two mechanisms of premature ovarian failure?
Dysfunction of follicular maturation
Depletion of the follicular pool
What are some of the rare causes of premature ovarian failure?
X chromosome abnormalities
Turner syndrome
Chemotherapy/Radiotherapy
What is turner syndrome?
A chromosomal disorder affecting females in which one X chromosome is absent or partially absent.
How does turner syndrome impact the female reproductive system?
Increases the rate of loss of eggs causing the ovaries not to develop normally and become streak ovaries.
What is the effect of streak ovaries on hormonal levels?
Streak ovaries causes hypogonadism and low oestrogen levels.
Increased levels of LH and FSH.
How can fragile X syndrome affect the female reproductive system?
Fragile X is associated with primary ovarian insufficiency.
Autoimmune oophrotitis
A rare condition in which the bodies own immune system mistakenly attacks it’s own ovaries causing inflammation, atrophy and fibrosis.
Hypothyroidism can cause primary ovarian failure
Hypothyroidism can cause primary ovarian failure
Diabetes can cause primary ovarian failure
Diabetes can cause primary ovarian failure
What are the treatment of options available to someone suffering with premature ovarian failure?
Remove and freeze eggs for future.
HRT to protect bones form osteoporosis.
Psychological support.
What investigations are carried out in cases of primary ovarian failure?
HCG - ensuring not pregnant Prolactin levels - prolactinoma would stop menstruation FSH, LH and Oestradiol levels DHT and Testosterone levels Ultrasound scan
Why is an ultrasound scan carried out in POF?
To determine endometrial thickness.
Ovarian volume
Antral follicle count
What is anti-mullerian hormone?
A glycoprotein structurally similar to inhibin.
What is anti-mullerian hormone produced by and thus when?
Anti-mullerian hormone is produced by the granulosa cells of the ovary during follicular development and is therefore not produced after menopause.
Why is it useful to test anti-mullerian levels?
AMH is useful for determining ovarian reserve.
In women with POF what general measures should be taken to avoid bone loss?
Physical activity
Calcium rich diet
Vitamin D supplementation
Avoiding smoking/drinking alcohol
Why do decreased oestrogen levels result in osteoporosis?
Oestrogen inhibits IL-6 secretion. IL-6 stimulates recruitment of osteoclasts.
Thus the decreased oestrogen from menopause = increased IL-6 production and thus more osteoclasts.
