Menopause, Infertility, PCOS Flashcards
what is the definition of menopause?
permanent cessation of menstruation
defined retrospectively after 1 year of amenorrhea without any other pathological cause
what is the range of menopause years?
45-55 y/o (mean 51)
what is the biggest factor affecting menopause? others?
GENETICS - biggest
others: tobacco use, chemo, radiation, hysterectomy
how does tobacco affect menopause?
tobacco use decreases age of menopause by 2 years
what is primary ovarian insufficiency/premature ovarian failure?
premature menopause (before the age of 40)
at what age is premature menopause?
40 y/o
what are the stages of menopause?
(1) peri-menopause (menopausal transition)
(2) menopause
(3) post-menopause
at how many years does peri-menopause (menopausal transition) occur?
47 y/o - 4 years before menopause
when is peri-menopause? what’s happening in it?
right before menopause occurs
at this stage egg viability declines before there is any measurable hormonal decrease (ex: FSH, LH)
QUALITY OF EGGS GO DOWN
are hormones recommended at peri-menopause?
NO!!!
what is peri-menopause a sign of?
ovarian decline
what is happening to the menstrual cycle length in peri-menopause?
menstrual cycle length increases and then gets shorter closer to menopause
what is the pathophysiology of menopause?
decline in quantity and quality of follicles and oocytes
granulosa cells in follicles stop making estrogen and inhibin
loss of inhibin means loss of negative feedback loop to hypothalamus and pituitary -> thus, FSH and LH increase in production by pituitary
ovary can’t respond to FSH
permanent amenorrhea once all follicles are depleted
what does the loss of inhibin in menopause cause? and what does this lead to?
causes loss of negative feedback loop to hypothalamus and pituitary -> thus, FSH and LH increase in production by pituitary
menopause is what type of dx?
clinical dx
if <40 y/o and have menopause what must be done? why?
complete evaluation b/c not normal age for menopause
if 40-45 y/o and have menopause, what must be done? what must be ruled out?
evaluation similar to workup of oligo/amenorrhea
other causes of menstrual dysfunction must be ruled out
if >45 y/o and have menopause what is not recommended?
diagnostic testing is not recommended
what other considerations/situations do you need to work up for dx of menopause?
underlying menstrual disorders (ex: PCOS need FSH work-up)
OCPs (if taking them late in age b/c suppresses HPO axis)
Hysterectomy (won’t be able to tell menopause based on irregular cycle b/c there’s no uterus -> need FSH measurement)
if menopause and had hysterectomy what labs do you need?
FSH levels b/c won’t be able to tell menopause based on irregular cycles since no uterus
what is the HALLMARK sx of menopause?
hot flashes
-get sudden sensation of heat in upper chest and face and then centralizes throughout the body
other sx’s of menopause?
sleep disturbances, mood changes (depressed, anxiety), cognitive changes, vaginal dryness, decreased sexual function/activity, breast pain and tenderness, joint pain and aches
dyspareunia (b/c of vaginal atrophy/dryness)
DECREASE IN BONE DENSITY
why does vaginal dryness occur in menopause?
b/c epithelial lining of vagina and urethra are estrogen dependent tissues and in menopause have decline of estrogen
urinary sx’s of menopause?
incontinence, urgency, recurrent UTIs
recurrent UTIs can be fixed with estrogen replacement b/c related to estrogen deficiency