PBL 1

Question 1

what is menopause?

Answer 1

when a woman has had amenorrhoea (no menstruation) for 12 months.

Question 2

what is early menopause?

Answer 2

when menopause comes between the ages of 40-45

Question 3

what are some risks once menopause occurs?

Answer 3

increased risk of osteoporosis, dementia and cardiovascular disease (if HRT is not managed appropriately)

Question 4

describe the hormonal changes of menopause?

Answer 4

We get a decrease in follicle numbers and so a decrease in FSh and LH binding sites which leads to a reduction in oestrogen secretion

Question 5

why do women get irregular vaginal bleeding around menopause?

Answer 5

from anovulatory cycles where the endometrium has proliferated under oestrogen without the balance of progesterone from the corpus luteum

Question 6

what is oestrogen breakthrough bleeding?

Answer 6

when ovulation does not occur and the endometrial lining breaks down

Question 7

describe urogenital changes after menopause?

Answer 7

there is atrophy of the vagina and thinning of the myometrium. thinning of the vaginal walls and dryness which can cause dyspareunia

Question 8

describe how bone density can change at menopause?

Answer 8

the drop in oestrogen causes increased bone reabsorption which results in an accelerate loss of bone density

Question 9

how does oestrogen protect against ischaemic heart disease?

Answer 9

its thought that oestrogen reduced LDL cholesterol and raises HDL cholesterol

Question 10

what are the 3 main types of naturally occurring oestrogens?

Answer 10

estrone
estradiol
estriol

Question 11

when is estrone prominent?

Answer 11

during menopause

Question 12

when is estradiol prominent?

Answer 12

during reproductive years

Question 13

when is estriol prominent?

Answer 13

during pregnancy

Question 14

why do people with a larger BMI not feel the effects of menopause so much?

Answer 14

As Oestrogen is produced in fat cells after menopause

Question 15

describe the mechanism of action of oestrogen?

Answer 15

Actions are mediated by the oestrogen receptors (ER), a dimeric nuclear protein that binds to DNA and controls gene expression.
Oestrogen enters passively into the cell where it binds to and activates the oestrogen receptor. The ER complex binds to specific DNA sequences called a hormone response element to activate transcription of target genes.
Oestrogen enters all cells, so its actions are dependent on the presence of the ER in the cell - it is in the ovary, uterus, and breast.

Question 16

what are the functions of oestrogen in females?

Answer 16

They promote the development of female secondary sexual characteristics, such as breasts, and are also involved in the thickening of endometrium and other aspects of regulating the menstrual cycle.

Question 17

what’s the function of oestrogen in males?

Answer 17

oestrogen regulates functions important to the maturation of sperm and a healthy libido.

Question 18

what is progesterone?

Answer 18

a progestogen in the body

Question 19

outline the biosynthesis of progesterone?

Answer 19

it is synthesised from pregnenalone, derived from cholesterol

Question 20

what are the functions of progesterone in a female?

Answer 20

Converts endometrium to secretory stage to prepare uterus for implantation.
Makes vaginal epithelium and cervical mucus thick and impenetrable to sperm.
Anti-mitogenic in endometrial epithelial cells, and so mitigates effects of oestrogen.

Question 21

describe the mechanism of mefenamic acid?

Answer 21

NSAID
Competitive inhibitor of COX (1 and 2) which are responsible for the first committed step in prostaglandin biosynthesis.
Decreasing the activity of COX reduces the production of prostaglandins, which are implicated in inflammation and pain processes.

Question 22

describe the mechanism of tranexamic acid?

Answer 22

Inhibits plasminogen activation and thus prevents fibrinolysis- this means the blood clot can remain and stop the bleeding
Used to reduce haemorrhage.