Menopause and Premature Ovarian Failure

Question 1

Menopause

Answer 1

Last menstrual period - 12 months without menstruation with no other cause.

Question 2

Perimenopause

Answer 2

The years leading up to menopause, associated with fluctuating levels of oestrogen due to declining ovarian function.

Question 3

Vasomotor symptoms of menopause

Answer 3

Hot flushes
Night sweats
Palpitations
Insomnia

Question 4

Psychological symptoms of menopause

Answer 4

Irritability

Depression

Question 5

Sexual symptoms of menopause

Answer 5

Decreased libido

Dyspareunia

Question 6

Dyspareunia

Answer 6

Painful intercourse

Question 7

Urogenital symptoms of menopause

Answer 7

Atrophic Vaginitis
Vaginal dryness
Urge incontinence / frequency
Urethral symptoms

Question 8

What are the long term circulation problems of menopause?

Answer 8

Cardiovascular disease

Cerebrovascular disease

Question 9

What are the long term skeletal problems of menopause?

Answer 9

Osteoporosis
Hip-fracture
Vertebral fracture

Question 10

Why is there a decrease in oestrogen in menopause?

Answer 10

There is a reduced number of ovarian follicles.

less follicles = less oestrogen

Question 11

How are LH and FSH levels affected in menopause?

Answer 11

To try and increase levels of oestrogen there is an increase in GnRH and thus increased LH and FSH.

Question 12

In premenopausal women oestradiol is produced by what cells of the developing follicle?

Answer 12

Granulosa cells produce oestradiol

Question 13

Premature menopause

Answer 13

A condition in which menstrual periods stop before age 40. This can cause fertility problems and symptoms of menopause.

Question 14

Premature ovarian failure

Answer 14

A condition in which a woman ovaries stop functioning normally before she is 40.

Question 15

Why do androgenic features begin to develop in menopause?

Answer 15

Decreased oestrogen results in increased LH. LH cannot stimulate follicles to produce oestrogen anymore and so androgen’s are produced instead.

Question 16

A 40yr old woman experiencing shorter menstrual cycles is likely what?

Answer 16

Peri-menopausal

Question 17

Where is there an increase in oestradiol levels in peri-menopausal women?

Answer 17

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.

Question 18

HRT

Answer 18

Hormone replacement therapy

Question 19

What is the main use of providing HRT?

Answer 19

HRT is normally provided to help protect bone mineralisation.
> lessens the symptoms of menopause.

Question 20

What are the risks of HRT?

Answer 20

Increased risk of breast cancer, endometrial cancer, venous thromboembolism and gallbladder disease.

Question 21

How is premature ovarian failure clinically defined?

Answer 21

4 months of amenorrhoea

FSH levels >30iu/ml

Question 22

What are the two mechanisms of premature ovarian failure?

Answer 22

Dysfunction of follicular maturation

Depletion of the follicular pool

Question 23

What are some of the rare causes of premature ovarian failure?

Answer 23

X chromosome abnormalities
Turner syndrome
Chemotherapy/Radiotherapy

Question 24

What is turner syndrome?

Answer 24

A chromosomal disorder affecting females in which one X chromosome is absent or partially absent.

Question 25

How does turner syndrome impact the female reproductive system?

Answer 25

Increases the rate of loss of eggs causing the ovaries not to develop normally and become streak ovaries.

Question 26

What is the effect of streak ovaries on hormonal levels?

Answer 26

Streak ovaries causes hypogonadism and low oestrogen levels.

Increased levels of LH and FSH.

Question 27

How can fragile X syndrome affect the female reproductive system?

Answer 27

Fragile X is associated with primary ovarian insufficiency.

Question 28

Autoimmune oophrotitis

Answer 28

A rare condition in which the bodies own immune system mistakenly attacks it’s own ovaries causing inflammation, atrophy and fibrosis.

Question 29

Hypothyroidism can cause primary ovarian failure

Answer 29

Hypothyroidism can cause primary ovarian failure

Question 30

Diabetes can cause primary ovarian failure

Answer 30

Diabetes can cause primary ovarian failure

Question 31

What are the treatment of options available to someone suffering with premature ovarian failure?

Answer 31

Remove and freeze eggs for future.
HRT to protect bones form osteoporosis.
Psychological support.

Question 32

What investigations are carried out in cases of primary ovarian failure?

Answer 32

HCG - ensuring not pregnant
Prolactin levels - prolactinoma would stop menstruation
FSH, LH and Oestradiol levels
DHT and Testosterone levels
Ultrasound scan

Question 33

Why is an ultrasound scan carried out in POF?

Answer 33

To determine endometrial thickness.
Ovarian volume
Antral follicle count

Question 34

What is anti-mullerian hormone?

Answer 34

A glycoprotein structurally similar to inhibin.

Question 35

What is anti-mullerian hormone produced by and thus when?

Answer 35

Anti-mullerian hormone is produced by the granulosa cells of the ovary during follicular development and is therefore not produced after menopause.

Question 36

Why is it useful to test anti-mullerian levels?

Answer 36

AMH is useful for determining ovarian reserve.

Question 37

In women with POF what general measures should be taken to avoid bone loss?

Answer 37

Physical activity
Calcium rich diet
Vitamin D supplementation
Avoiding smoking/drinking alcohol

Question 38

Why do decreased oestrogen levels result in osteoporosis?

Answer 38

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.