menopause and reproductive system

Question 1

reproductive hormones

Answer 1

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

Question 2

menopause

Answer 2

menopause- last menstrual period
perimenopause/climacteric- period immediately preceding or within 12 months after menopause
postmenopaual- >12mo since last menstrual period

Question 3

menopause history

Answer 3

aristotle, hippocrates, roman authors- early 40s
previous age at menopause and LE
1900- AM~50, LE ~50.1
1990- AM ~50 LE~79.2

Question 4

age at natural menopause

Answer 4

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

Question 5

changes in fertility

Answer 5

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

Question 6

changes in reproductive function with age

Answer 6

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

Question 7

oestrogen

Answer 7

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

Question 8

symptoms of menopause

Answer 8

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

Question 9

symptoms prior to menopause

Answer 9

perimenstrually
- dysmenorrhoea- endometreosis
- backache
- fatigue
- increased migraine risk

premenstrually
- weight gain
- skin problems
- irritablity
- breast tenderness
- depression

Question 10

physical changes w menopause

Answer 10

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

Question 11

changes in CVD risk factors

Answer 11

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

Question 12

effects of oestrogen deficiency

Answer 12

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

Question 13

advantages of menopause

Answer 13

no period symptoms
grandmother hypothesis
stops pregnancy which limits population growth

Question 14

menopause and hormone replacement therapy

Answer 14

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

Question 15

HRT and CHD mortality

Answer 15

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

Question 16

HRT adv + dis

Answer 16

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

Question 17

male reproductive endocrinology

Answer 17

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

Question 18

correlates of sex hormone changes in men

Answer 18

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

Question 19

changes in women- summary

Answer 19

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

Question 20

changes in men- summary

Answer 20

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