Menopause & 'Andropause'

Question 1

Symptoms of menopause?

Answer 1

Lack of estradiol:
Skin dryness/hair thinning
Hot flushes/ sweating/ sleep disturbance
Mood disturbance
Osteoporosis - decreased bone mineral density (BMD)
(E2 stimulates osteoblasts)
Sexual dysfunction- vaginal dryness, decreased libido
Weight gain
Amenorrhoea- peri- within 1 year of LMP, post - after 1 yr
Cessation of fertility
Climacteric - irregular periods in years close to menopause

Question 2

Treatment of menopause?

Answer 2

Oestrogen replacement - HRY (hormone replacement therapy)

Oestrogen stimulates the endometrium
Add progesterone - if endometrium is intact to prevent risk of endometrial hyperplasia/cancer

Question 3

ovarian reserve markers? 
What age does menopause occur? 
Early menopause (premature ovarian insufficiency POI)? Symptoms? Causes?

Answer 3

Anti-mullerian hormone (AMH) is an ovarian reserve marker.
AMH Peaks in early adult life
AMH is v low at menopause
AMH found in granulosa cells in ovaries

Menopause age range: 45-55 yrs
Median age: 51 yrs

Only 1% menopause <40 yrs old (premature)

Early menopause: premature ovarian insufficiency (POI)
Same symptoms as per menopause
Used to be called premature ovarian failure POF
Conception can happen in 20%
Diagnosis high FSH>25 iU/L (x2 at least 4 weeks apart)

Causes:
Autoimmune
Genetic (eg fragile X syndrome/turners syndrome)
Cancer therapy (radio/chemo therapy in the past)

Question 4

Andropause?
Testosterone - free hormone hypothesis
Testosterone rhythm?

Answer 4

Late onset Hypogonadism
Testosterone - free hormone hypothesis
Binding of total testosterone in circulation
Albumin weakly binds testosterone bioavailable, 38% albumin-bound testosterone, 60% SHBG-bound testosterone
SHBG strongly binds testosterone ‘unavailable’
2% ‘free testosterone’ ACTIVE

Total testosterone is unchanged
But SHBG is increased
Free testosterone reduced

Testosterone has a diurnal rhythm: higher in the morning, measure it before 11 am
Can fall ~20% w sugar, ideally measure it fasting

Question 5

Testosterone deficiency symptoms?

Answer 5

Sexual dysfunction- reduced libido
Erectile dysfunction&raquo_space; loss of early morning erections
Hair growth - frequency of shaving?
Energy levels - general well-being, fatigue
Mood disturbance
Body composition - increased fat/ reduced muscle mass, gynaecomastia (breast enlargement in man)
Spermatogenesis (high levels of intratesticular testosterone needed)
Bone health - via conversion to oestrogen