Session 5- The Patient in Menopause Flashcards
what is menopause
when menstruation stops and the woman is no longer able to reproduce
it can be defined as menopause when there has been a permanent cessation of menstruation for 12 consecutive months
occurs when there are no primary follicles left and when the ovaries are no longer able to produce follicles, oestrogen levels start to decline
average age of women starting menopause
50
45-55
what happens during pre-menopause
initial changes that occur to a menstrual cycle
menstrual cycle often shortens, ovulation is either early or absent and so problems with fertility can occur
oestrogen levels fall- negative feedback on HPG axis is removed and therefore levels of LH and FSH rise.
why does FSH rise higher in pre menopause
FSH will rise more than LH because of the removal of inhibin on the HPG axis
what happens during peri-menopause
the transition phase where additional physiological changes occur such a s mood swings and hot flushes leading ultimately to greater infrequency of menstruatiion
what happens during menopause
this is when there has been a complete cessation of menstrual periods for 12 months
what happens during post menopause
when there are no follicles left and she is no longer able to concieve
what bone disease can menopause lead to
reducing levels of oestrogen enhance osteoclast activity because normally oestrogen inhibits osteoclasts
- more bone is absorbed
- increased calcium loss from bone
OSTEOPOROSIS
Oestrogen and the CVS system
low levels of oestrogen and progesterone cause changes in the lipid profile in postmenopausal women. Increased circulating lipid levels
risk of - atherosclerosis stroke, MI
Non-hormonal management of menopause
this relates to general lifestule advice that can help with vasomotor symptoms and dietary advice to reduce weight gain and CVS risk
hormonal management of Menopause
this involves replacing oestrogen. The main inidication for HRT are to help manage the symptoms related to low levels of oestrgen
how do oocyte change with age
they quality and quantity goes down
what do we measure to diagnose menopause
FSH
oestrigen is too low or absent so cant measure that
physiological symtoms of menopause
itching restless limbs change in body temp sleep changes bloating mood changes and forgetfulness
what causes the hot flushes
loss of oestrogen
what changes happen to the ovary in menopause
the ovaries become smaller
-oestrogen production decreases
how does lack of oestrogen affect the urogenital mucosa
lack of collagen synthesis and bloof low in vaginal epithelium and glycogen production - vaginal pH goes up
- increase dryness
- increase irrtation
- increase infection
how does menopause affect the GI system
motor activity of the entire digestive tract is diminished after menopause
-the intestines tend to be sluggish resulting in constipation
how does menopause affect the urinary system
as the oestrogen level decrease after menopause the tissue lining the urethra and the bladder become drier thinner and less elastic
- changes in bladder
- loss of pelvic tone
- urinary incontinence
- this can lead to increased frequency of passing urine as well as an increased tendancy to develop UTI
How does the uterus change in menopause
it becomes small and fibrotic due to atrophy of the muscles
regression of endometrium
shrinkage of myometrium
cervix becomes smaller and thinner
vaginal rugae lost
how do the external genital organs change
vulva
-the fat in labia majora and mons pubis decreases and pubic hair become spare
breast
- in thin they become flat and shrivled
- in heavy they become flabby and pendulous
