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SA reproductive > S10) Menopause > Flashcards

S10) Menopause Flashcards

1
Q

What is menopause?

A

Menopause is the permanent cessation of menstruation (12 consecutive months), with no associated physiological causes, at the end of reproductive life due to total loss of ovarian follicular activity

  • oestrogen levels fall dramatically and FSH and LH levels rise. FSH rise more as no Inhibin
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2
Q

What is physiological menopause?

A

Physiologic menopause is the normal decline in ovarian function due to ageing (45 - 55), resulting in infrequent ovulation, decreased menstrual function and eventually cessation of menstruation

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3
Q

What is pathological menopause?

A

Pathological menopause is the gradual/abrupt cessation of menstruation < 40 years occur idiopathically (5% of women)

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4
Q

What are the 4 phases of menopause?

A
  • Pre-menopause
  • Peri-menopausal (transition menopause)
  • Menopause
  • Post menopause
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5
Q

Describe 4 physiological features of the pre-menopause phase (peri-menopausal)

A
  • Changes in menstrual cycle (follicular phase shortens, early/absent ovulation)
  • Less oestrogen secreted
  • LH & FSH levels rise
  • Reduced fertility
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6
Q

What is observed in the perimenopause phase?

A

The perimenopausal phase is characterised by the physiological changes associated with the end of reproduction capacity and terminates with the completion of menopause

  • follicular phase shortens
  • ovulation is early or absent
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7
Q

What is the post-menopausal phase?

A

The post-menopausal phase is the time after which a women has experienced 12 consecutive months of amenorrhea without period

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8
Q

In four steps, outline the concept of ‘burning out the ovaries’

A

⇒ In reproductive life, ~400 primordial follicles grow & ovulate

⇒ At ~45 years old, only a few primordial follicles remain to be stimulated by FSH & LH

⇒ Production of oestrogen by ovaries decreases gradually

⇒ Inhibition gonadotrophins (FSH, LH) decreases

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9
Q

Which hormone is measured to diagnose physiological menopause?

A

FSH, not oestrogen because it arises from locations other than ovaries

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10
Q

Identify 5 early consequences of oestrogen deficiency

A
  • Hot flushes
  • Sweating
  • Insomnia
  • Menstrual irregularity
  • Psychological changes
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11
Q

Identify 5 intermediate consequences of oestrogen deficiency

A
  • Vaginal atrophy
  • Dyspareunia
  • Skin atrophy
  • Stress urinary incontinence
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12
Q

Identify 3 late consequences of oestrogen deficiency

A
  • Osteoporosis
  • Atherosclerosis (CVD & CHD)
  • Alzheimer’s disease
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13
Q

Describe the causes and treatment of hot flushes

A
  • Hot flush occurs due to vascular changes and transient rises in skin temperature
  • Relieved by oestrogen treatment
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14
Q

Explain why dysfunctional uterine bleeding occurs in the pre/perimenopause phases

A
  • Continued oestrogen thickens endometrium (hyperplasia)
  • No ovulation = no progesterone = no corpus luteum

Leads to a late menstrual period followed by irregular bleeding and spotting

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15
Q

How does dysfunctional uterine bleeding present?

A
  • Spotting between cycles
  • Extremely heavy bleeding
  • Mid-cycle bleeding
  • Longer, shorter / unpredictable lengths of time between periods
  • Longer, shorter / unpredictable durations of periods
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16
Q

Describe the manifestations of the psychological changes in menopause

A
  • Frequent headache
  • Irritability
  • Fatigue
  • Depression
  • Insomnia
  • memory loss
17
Q

Describe the general changes in appearance which accompanies menopause

A
  • Skin: loses its elasticity, becomes thin and fine due to loss of elastin and & collagen
  • Weight: likely increase around hips, waist & buttocks due irregular food habit (mood swing)
  • Hair: becomes dry, coarse (± hair loss due to oestrogen decrease)
  • Voice: becomes deeper as vocal cords thicken (oestrogen decrease)
18
Q

Why do menopausal women often present with constipation?

A
  • Diminished motor activity of the entire GI tract
  • Intestines tend to be sluggish
19
Q

Why do menopausal women often present with urinary incontinence and UTIs?

A
  • Oestrogen decrease results in the tissue lining the urethra and bladder becoming drier, thinner and less elastic
  • Changes in bladder due to loss of pelvic tone
20
Q

How do the internal genital organs change during menopause?

A
  • Regression & shrinkage of endometrium
  • Cervix becomes smaller & thinner and appears to flush with vagina, which loses its rugae
21
Q

How do the external genital organs change during menopause?

A
  • Vulva – decrease in fat in the labia majora & mons pubis
  • Breast – flat and shrivelled (thin women) or remain flabby and pendulous (heavy women)
22
Q

Why are post-menopausal women at high-risk of osteoporosis?

A
  • Bone mass reduces by 2.5% per year for several years (Ca2+ moves out)
  • Reduced oestrogen enhances osteoclast ability to absorb bone
23
Q

Why is there a gradual rise in the risk of heart disease and stroke after menopause?

A

Lack of oestrogen and progesterone:

  • Increases plasma cholesterol (hyperlipidemia)
  • Increases in systolic and diastolic pressure (hypertension)
  • Carbohydrate tolerance decreases (diabetes)
24
Q

Outline the non-hormonal treatments of menopause

A
  • Hot flushes & night sweats: dressing in light layers, avoid caffeine, alcohol and spicy foods
  • Weight gain: lifestyle changes (dietary fat intake & exercise)
25
Q

HRT is indicated in menopausal women to overcome the short-term and long- term consequences of oestrogen deficiency.

How can it be administered?

A
  • Orally (pill form)
  • Vaginally (as a cream)
  • Transdermally (in patch form)
26
Q

What are the possible disadvantages to HRT?

A
  • Heart disease
  • Stroke
  • Mental decline
  • Breast cancer
  • Ovarian cancer
27
Q

Why aren’t oestrogen only preparations given to women who haven’t had a hysterectomy?

A

Oestrogen causes endometrial proliferation outside the uterus, possibly causing endometrial cancer

28
Q

what is pre menopause

A
  • 40+ years
  • less oestrogen secreted
  • LH, FSH levels rise, more in FSH
  • can result in reduced fertility
29
Q

what happens to the function and quality if oocytes as Age increases

A

decreases, the one left are the worst of the bunch

30
Q

effect to the GI tract and the urinary system

A

GI tract:

motor function deminishes => sluggish movement of the intestines

Urinary:

lining of the urethra and the bladder => drier and thinner and less elastic

urinary incontinence

reduced elasticity of bladder

31
Q

what does the reduced amount of oestrogen cause in the genital organs

A

thinning of vaginal skin = can cause severe dyspareunia (painful intercourse)

lack of glycogen - rise in vaginal pH more likely for an infection

thinning of cervix

32
Q

what are the benefits of HRT

A
  • reduction in vasomotor symptoms
  • improvement in mood swings
  • reduction of oestoperosis
  • lower risk of colorectal cancer
33
Q

risk of HRT

A
  • only associated with oral
  • slight increase of stroke risk
  • if it contains oestrogen and progesterone it can increase chance of breast cancer

SA reproductive (22 decks)

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