Physiology and regulation of menopause

Question 1

what is menopause

Answer 1

the permanent cessation of menstruation, which marks the end of biological reproductive competence

Question 2

what does menopause result in

Answer 2

loss of ovarian follicular activity, resulting in a decrease in quality and quantity of oocytes in ovarian follicles

Question 3

what causes menopausal symptoms

Answer 3

loss of ovarian hormonal function
this does not directly affect uterine hormone responsiveness (pregnancy is still possible with exogenous hormone stimulation and ART)

Question 4

what are the physiological symptoms of menopause

Answer 4

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

Question 5

what are the psychological symptoms

Answer 5

dizziness
interrupted sleep patterns
anxiety
poor memory
inability to concentrate
depressive mood
irritability
mood swings
less interested in sexual activity

Question 6

what is transitional menstruation

Answer 6

shorter or longer cycles
bleeding between periods

Question 7

what are the long-term sequelae symptoms

Answer 7

accelerated cognitive impairment
accelerated CVD
autoimmune disease (adrenal, thyroid)
infertility
osteoporosis

Question 8

what is the average age of menopause

Answer 8

51
earlier than 40yrs is abnormal

Question 9

what are the causes of early menopause

Answer 9

primary ovarian insufficiency (altered suboptimal ovarian function and hormone production)
premature ovarian failure (ovaries stop fully functioning)

Question 10

what effects menopausal age

Answer 10

genetics
ethnicity
smoking
substance abuse
reproductive history
chemotherapy
pelvic radiation
oophorectomy
hysterectomy

Question 11

how is female reproductive ageing described

Answer 11

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

Question 12

what is the duration of ovarian functionality determined by

Answer 12

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

Question 13

what is premenopause

Answer 13

first menstrual cycle to first signs of menopause, HPG axis maintains reproductive competence and gonadal hormone secretion

Question 14

what is perimenopause

Answer 14

oestrogen levels decline and fluctuate, irregular menstrual cycle, variability in follicle development and ovarian secretion leading up to final menstrual period

Question 15

what leads to impaired fertility

Answer 15

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)

Question 16

what does reproductive ageing cause in the uterus

Answer 16

loss of muscle and eventual cessation of menstrual cycle

Question 17

reproductive ageing in ovaries

Answer 17

reduction in number of ovarian follicles maturing leading to gradual decline in fertility
levels of oestrogen begin to drop triggering the menopause

Question 18

reproductive ageing in the fallopian tubes

Answer 18

shrinkage in length, loss of ciliated epithelia and loss of mucosa contribute to loss of fertility

Question 19

reproductive ageing in vagina

Answer 19

loss of elacticity, shortening of length, reduction in vaginal secretion and thinning of epithelial lining all increase risk of tears, bleeding and infection

Question 20

reproductive ageing of the cervix opening

Answer 20

reduced cervical secretions

Question 21

effects of oestrogen

Answer 21

inhibits FSH
vaginal lubrication
endometrial changes
breast growth
bone growth
immune system
cardiovascular system
thermoregulation
mood

Question 22

overview of loss of ovarian function

Answer 22

exhaustion of ovarian follicles (oocyte apoptosis and follicle loss during menstrual cycles) and diminishing oocyte quality

Question 23

what is urogenital atrophy caused by

Answer 23

anatomy/function of the lower female genital tract is oestrogen-dependent

Question 24

what are the vasomotor symptoms of menopause

Answer 24

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

Question 25

mood and sleep changes

Answer 25

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

Question 26

what is highly correlated with hot flushes and depressed mood

Answer 26

myalgia and arthralgia

Question 27

what is the relationship between cardiovascular disease and menopause

Answer 27

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

Question 28

metabolic changes associated with menopause

Answer 28

loss of oestrogen is associated with metabolic changes and lower metabolic rate
menopausal women have increased visceral fat and adverse lipid profiles

Question 29

what is the management of menopause

Answer 29

lifestyle assessment and intervention
systemic hormone therapies
local vaginal therapies
non-hormone therapies