menopause and reproductive system Flashcards
reproductive hormones
GnRH - gonadotropin releasing hormone- production/release anterior pituitary hormones
FSH, LH- sex steroid production
oestrogen and progesterone- female reproductive system/menstrual cycle
testosterone- male reproductive system
menopause
menopause- last menstrual period
perimenopause/climacteric- period immediately preceding or within 12 months after menopause
postmenopaual- >12mo since last menstrual period
menopause history
aristotle, hippocrates, roman authors- early 40s
previous age at menopause and LE
1900- AM~50, LE ~50.1
1990- AM ~50 LE~79.2
age at natural menopause
meta analysis study
mean age at menopause- 48.8
lower in africa, latin america, asia and middle eastern countries
highest in australia and europe
smoking associated with early AMN
higher education or occupation associated with later menopasue
physical activity not assocuated after adjustement for covariats
overweight associated with later ANM but no effect of obesity
changes in fertility
number of primordial folliceles and quality
fertility declines with age and ceases at menopause
still possible to get pregnant later in life- just less likley
changes in reproductive function with age
follicular number- stable, then rapid decline at 40, after menopause drops to 0
menstruation- regular, then less regular then stops after menopause
FSH- increases with age, highest 50-55 then stops 70+
LH- same as FSH
oestrogens- higher when younger and drop as you age, none after menopause
oestrogen
there are oestrogen receptors found all around the body so oestrogen production (and loss of prod at menopause) will affect all of these tissues, leading to menopausal symptoms
symptoms of menopause
vasomotor symptoms
- hot flushes- preceded by LH surge, vasodilation of heat, sweating
- night swets
- affects 75% (is moderate in 28%)
- increased symptoms in smokers, high BMI
psychological symptoms
- depression, insomnia + tiredness (25%)
- impaired cognition
genitourinary symptoms in 50%
- thinning of tissue
- increased risk of UTI
symptoms prior to menopause
perimenstrually
- dysmenorrhoea- endometreosis
- backache
- fatigue
- increased migraine risk
premenstrually
- weight gain
- skin problems
- irritablity
- breast tenderness
- depression
physical changes w menopause
body mass- 2.5kg increase in body mass (up to 5kg in 20%)
fat distribution- increased WHR, increased intrabdominal fat
muscle- decline in muscle mass around menopasue, unclear whether this is due to menopause, ageing or changes in physical acitivity
changes in CVD risk factors
blood lipids/lipoproteins
total cholesterol increases by 6%
triglycerides increase by 11%
LDL increase by 8%
HDL decrease by 7%
magnitude of change correlated with magnitde of sex steroid change
effects of oestrogen deficiency
central brain effects- reduced satiety and increased food intake
sleep deprivation- desynchronisation of central and peripheral clocks
fatty liver
impaired endothelial function
insulin resistance - in muscle
advantages of menopause
no period symptoms
grandmother hypothesis
stops pregnancy which limits population growth
menopause and hormone replacement therapy
oestrogen (+ progesterone for those with uterus)- replaces endogenous hormones that are no longer synthesised
giving only oestogens would increase risk of uterine cancer so is given with progesterson as well
benefits- can reduce menopausal symptoms, preliminary increase in bone mass to make up for reduced bone mass
HRT and CHD mortality
study found increase in mortality with HRT
this led to decrease in the number of women taking HRT
however, stidy was done in women who were far past menopausal age, so did not have menopausal symptoms
therefore, HRT is okay during menopause but not a long time after
HRT adv + dis
advantages
- eases menopausal symptoms
- increases bone mass
disadvantages
- past concern about increased risk of coronary events but new new research shows no adverse effects in those ages 50-54
- slight increase in risk of breast cancer with combined oestrogen and progestins
male reproductive endocrinology
hormones- gonadotropin releases as in women but no cyclical
gonadotropin releasing hormone (GnRH) from hypothalamus
follicle stimulating hormone (FSH) and LH from anterior pituitary
target organ- testes- sperm and testosterone production
regulation- negative feedback
correlates of sex hormone changes in men
reproductive system
- testes- reduction in weight
- reduced number of leydig cells
- reduced testosterone production
- loss of cells in semiferrous tubules
- some replacement of sertoli cells with fibrous tissue
- reduced number of sperm per ejaculation
penis- increased fibrous tissue
function
- higher prevalence of impotence affecting a minority
- reduced fertility but not an abrupt cessation as in women
- no vasomotor symptoms
reduced muscle strength and mass
- no accelerated bone loss as in women
changes in women- summary
premenopause- high FSH, increased menstrual irregularity, fertility declines
perimenopause- increased FSH and LH, low estradiol, menstruation ceases, vasomotor symptoms
postmenopause- low FSH and LH, vasomotor symptoms and bone loss reduced using HRT
changes in men- summary
hormone levels
- gradual decrease in test and increase in FSH and LH
- considerable variation between individuals
associated changes- decline in fertility (not lost) and decline in muscle mass and strength
