Physiology and regulation of menopause Flashcards
what is menopause
the permanent cessation of menstruation, which marks the end of biological reproductive competence
what does menopause result in
loss of ovarian follicular activity, resulting in a decrease in quality and quantity of oocytes in ovarian follicles
what causes menopausal symptoms
loss of ovarian hormonal function
this does not directly affect uterine hormone responsiveness (pregnancy is still possible with exogenous hormone stimulation and ART)
what are the physiological symptoms of menopause
weight gain
night sweats
headache
palpitations
enlarged, painful breasts
skin - hot flashes, dryness, itching, thinning, tingling
sore, stiff joints
back pain
urinary incontinence or urgency
vaginal dryness
painful sex
what are the psychological symptoms
dizziness
interrupted sleep patterns
anxiety
poor memory
inability to concentrate
depressive mood
irritability
mood swings
less interested in sexual activity
what is transitional menstruation
shorter or longer cycles
bleeding between periods
what are the long-term sequelae symptoms
accelerated cognitive impairment
accelerated CVD
autoimmune disease (adrenal, thyroid)
infertility
osteoporosis
what is the average age of menopause
51
earlier than 40yrs is abnormal
what are the causes of early menopause
primary ovarian insufficiency (altered suboptimal ovarian function and hormone production)
premature ovarian failure (ovaries stop fully functioning)
what effects menopausal age
genetics
ethnicity
smoking
substance abuse
reproductive history
chemotherapy
pelvic radiation
oophorectomy
hysterectomy
how is female reproductive ageing described
gradual, progressive and ultimately accelerating loss of ovarian follicles, continued oocyte apoptosis and oocyte depletion during the 400-500 cycles of follicular recruitment in a normal reproductive lifespan
what is the duration of ovarian functionality determined by
extent and rapidity of oocyte apoptosis
age-related changes to oocyte quality parallel decrease in follicle number
leads to decreased fertilisation and conception rates, causing increased pregnancy loss
what is premenopause
first menstrual cycle to first signs of menopause, HPG axis maintains reproductive competence and gonadal hormone secretion
what is perimenopause
oestrogen levels decline and fluctuate, irregular menstrual cycle, variability in follicle development and ovarian secretion leading up to final menstrual period
what leads to impaired fertility
falling oestradiol, inhibin and AMH leads to loss of negative feedback, which increases GnRH, FSH and LH,
increased FSH before cycle irregularities (due to progressive follicular decline), progressive decline of inhibin B and AMH (follicular decline)
what does reproductive ageing cause in the uterus
loss of muscle and eventual cessation of menstrual cycle
reproductive ageing in ovaries
reduction in number of ovarian follicles maturing leading to gradual decline in fertility
levels of oestrogen begin to drop triggering the menopause
reproductive ageing in the fallopian tubes
shrinkage in length, loss of ciliated epithelia and loss of mucosa contribute to loss of fertility
reproductive ageing in vagina
loss of elacticity, shortening of length, reduction in vaginal secretion and thinning of epithelial lining all increase risk of tears, bleeding and infection
reproductive ageing of the cervix opening
reduced cervical secretions
effects of oestrogen
inhibits FSH
vaginal lubrication
endometrial changes
breast growth
bone growth
immune system
cardiovascular system
thermoregulation
mood
overview of loss of ovarian function
exhaustion of ovarian follicles (oocyte apoptosis and follicle loss during menstrual cycles) and diminishing oocyte quality
what is urogenital atrophy caused by
anatomy/function of the lower female genital tract is oestrogen-dependent
what are the vasomotor symptoms of menopause
abrupt drops in oestrogen levels disrupt hypothalamic thermoregulatory centre
leads to miscommunication between brain and vascular system, causes disruption of core body temperature and normal body temperature
mood and sleep changes
mood disorders are not caused by menopause, but vulnerable women may express first episode or relapse during menopausal transition
sleep disturbances may be secondary to vasomotor, and can also affect mood
what is highly correlated with hot flushes and depressed mood
myalgia and arthralgia
what is the relationship between cardiovascular disease and menopause
oestrogens promote vascular remodelling and elasticity, regulate reactive dilation and local inflammatory activity
loss of oestrogen may lead to impaired endothelial function and vascular changes
metabolic changes associated with menopause
loss of oestrogen is associated with metabolic changes and lower metabolic rate
menopausal women have increased visceral fat and adverse lipid profiles
what is the management of menopause
lifestyle assessment and intervention
systemic hormone therapies
local vaginal therapies
non-hormone therapies
