Menopauseand gonopause

Question 1

Outline the changes in LH and FSH during menopause. Why are they different?

Answer 1

• follicles fail to produce oestrogen and inhibin
• reduces negative feedback on FSH and LH
• FSH and LH rise
• inhibin only acts on FSH so rises dramatically more than LH

Question 2

Can postmenopausal women still produce oestrogen and why?

Answer 2

Yes. The ovaries only produce oestrodiol but peripheral tissues such as fat cells contain aromatase enzymes and can thus convert circulating androgens to oestrone. This is weak, however, and does not offer protection against osteoporosis etc.

Question 3

Outline the risks and benefits of postmenopausal oestrogen

Answer 3

Obese postmenopausal women may have enough adipocytes to secrete significant quantities of oestrone. This has similar circulatory influences to oestrogen and thus offers protection. However, as it is unopposed by progesterone (as with oestrogen only HRT), it stimulates endometrial hyperplasia without the associated menstruation. Prolonged hyperplasia and stimulation promotes neoplastic changes and risk of carcinoma.

Question 4

What are the signs and symptoms of menopause?

Answer 4

• hot flushes (mechanism unknown)
• vaginal atrophy: decreased lubrication thus predisposes to UTI and dyspareunia
• involution of breast tissue
• skin changes

Question 5

What is the link between osteoporosis and menopause?

Answer 5

• osteoblast activity is unaffected
• osteoclast activity increases, increasing reabsorption
• trabecular bone affected first
• ?PTH antagonism