Session 10 - Menopause Flashcards
What is menopause?
Menopause is the permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity.
What is menopause defined as?
Menopause is defined as the time when there has been no menstrual periods for 12 consecutive months and no other biological or physiological causes can be identified.
What does the decline in ovarian function due to ageing lead to?
Infrequent ovulation, decreased menstrual function and eventually cessation of menopause.
What are the four phases of menopause?
Pre-menopause
Peri-menopause
Menopause
Post menopause
What is pre-menopause? What happens during this phase?
The time prior to menopause.
- changes in menstrual cycle start to occur (follicular phase shortens, ovulation early or absent)
- less oestrogen secreted
- LH and FSH levels rise, particularly FSH, because of reduced negative feedback
- reduced fertility
What is peri-menopause? What happens during this phase?
The transition phase from reproductive life to menopause.
- characterised by physiological changes associated with the end of reproductive capacity
- terminates with the completion of menopause
What is the post-menopausal stage?
It is defined as the time after which a woman has experienced 12 consecutive months of amenorrhoea
What is the cause of menopause?
As women age, the ovaries become depleted of follicles and no amount of gonadotrophins will encourage them to work. This means that no more follicles develop so cessation of menstrual cycle occurs.
Which hormone is measured to diagnose physiological menopause?
FSH
FSH levels will be high as during menopause oestrogen and inhibin production decline, meaning the negative feedback on FSH production is removed.
What are the early consequences of oestrogen deficiency?
Hot flushes Sweating Insomnia Menstrual irregularity Psychological symptoms
What are the intermediate consequences of oestrogen deficiency?
Vaginal atrophy
Dyspareunia (painful sexual intercourse)
Skin atrophy
Urge-stress incontinence
What are the late consequences of oestrogen deficiency?
Osteoporosis
Atherosclerosis - coronary heart disease, cardiovascular disease
Alzheimer’s disease
What are hot flushes?
Transient rises of skin temperature over face, chest, neck and head. Followed sometimes by refuse perspiration.
What kinds of dysfunctional uterine bleeding can menopausal women experience?
Spotting between cycles
Extremely heavy bleeding
Mid-cycle bleeding
Longer, shorter or unpredictable lengths of time between periods
Longer, shorter or unpredictable lengths of periods
What psychological changes are seen in menopause?
Frequent headache Irritability Fatigue Depression and insomnia Diminished interest in sex (maybe due to emotional upset or secondary to painful intercourse due to dry vagina)
What changes occur to the ovaries during menopause?
The ovaries become smaller (atrophy)
What changes occur to general appearance during menopause?
Skin - losses elasticity, becomes thin. Due to loss of elastin and collagen.
Weight - increases, likely due to irregular eating habits due to mood swings. Fat deposited around hips, waist and buttocks.
Hair - becomes dry and coarse after menopause, maybe hair loss due to decreased oestrogen
Voice - deepens due to thickening of vocal cords
What change are seen in the digestive system due to menopause?
Motor activity of the entire digestive tract is diminished after menopause. Results in constipation.
What are the changes seen in the urinary system as a result of menopause?
Tissue lining the urethra and bladder becomes drier, thinner and less elastic (due to decreased oestrogen). Loss of pelvic tone. Urinary incontinence. Increased frequency . Increased tendency to develop UTIs.
What changes in the uterus occur due to the menopause?
Uterus becomes small and fibrotic due to atrophy of the muscles (shrinkage of myometrium and regression of endometrium).
What changes to the cervix occur due to the menopause?
Cervix becomes smaller and appears to merge with the vagina.
In older women the cervix may be impossible to distinguish from the vagina due to:
- thinning of cervix
- loss of vaginal rugae
What changes are seen in the vulva due to menopause?
The fat in the labia majora and the mons pubis decreases and pubic hair becomes sparse.
What changes are seen in the breasts due to menopause?
In thin women the breasts become flat and shrivelled.
In heavy women the breasts remain flabby and pendulous.
Why are post-menopausal women at increased risk of developing osteoporosis?
Reduced oestrogen means increased osteoclasts activity. Therefore greater breakdown of bone.
What non-hormonal treatments can be used to alleviate the symptoms of menopause?
Dressing in light layers to alleviate hot flushes.
Avoid caffeine, alcohol and spicy foods.
Reduce dietary fat intake.
Regular exercise.
What treatment can be used to treat the consequences of menopause?
Hormone replacement therapy (HRT)
In what ways can HRT be administered?
In pill form
Vaginallly (as a cream)
Transdermally (in patch form)
What are the possible disadvantages of HRT?
Increased risk of certain types of cancer.
Increased risk of blood clots.
Side effects, e.g. bloating, breast tenderness, nausea, leg cramps, vaginal bleeding, etc.
