the physiology and regulation of menopause W10 Flashcards
what is menopause?
permeant cessation of menstruation
what does menstruation mark the end of?
reproductive competence
how is menopause confirmed?
12 months of amenorrhea
what does menopause occur as a result of?
menopause occurs due to loss of ovarian follicular activity and loss of ovarian hormonal function
explain the loss of ovarian follicular activity during menopause
decrease in both quality and quantity of oocytes residing in ovarian follicles
how may a postmenopausal woman get pregnant?
exogenous hormonal stimulation
examples of iatrogenic menopause (secondary menopause)?
chemotherapy causing premature ovarian failure
surgical removal of both ovaries
physiological symptoms of menopause - categories
weight gain
heavy night sweats
palpitations
headache
back pain
breast enlargement and pain
urinary incontinence and urgency
vaginal dryness and painful intercourse
sore and stiff joints
transitional menstruations
psychological symptoms
skin symptoms
skin symptoms in menopause?
hot flashes
dryness
itching
thinning
tingling
psychological symptoms in menopause?
dizziness
interrupted sleeping patterns
anxiety
poor memory
inability to concentrate
depressive mood
irritability
mood swings
less interest in sexual activity
features of transitional menstruations
shorter or longer cycles
bleeding between periods
long term sequelae of menopause
accelerated cognitive impairment
accelerated cardiovascular disease
autoimmune disease
infertility
osteoporosis
average age of menopause?
51 years (typical range 45-55)
what age range does abnormal menopause occur in?
what can this be due to?
under 40 years
primary ovarian insufficiency
premature ovarian failure
factors affecting menopausal age?
genetics, ethnicity
smoking/substance abuse
reproductive history
chemotherapy or pelvic radiation
oophorectomy or hysterectomy
what hormones do postmenopausal ovaries produce
androstenedione and testosterone
effect of androstenedione and testosterone in post-menopause?
converted to estrone in fat, muscle and skin. estrone is a weak form of estrogen
what has high levels of estrone been linked to?
high levels of estrone has been linked to growth of breast and endometrial cancer
recap of menstrual cycle endocrinology?
rising FSH at beginning of cycle promotes new follicular cohort
FSH stimulates estrogen, inhibins, AMH
estrogen levels trigger LH surge
following ovulation, LH secretion maintains progesterone secretion from corpus luteum. progesterone inhibits GnRH pulse frequency
loss of negative feedback from waning corpus luteum results in FSH rise
what causes shorter cycle intervals in menopausal transition?
smaller less functional follicles (due to age) produce lower levels of estradiol, inhibin, AMH.
leads to increase of FSH production, overshoot of estradiol production. facilitates and accelerates LH surge, accounts for shorter cycle intervals
what do falling estrogen, inhibin and AMH levels in menopause lead to
loss of negative feedback leading to increased GnRH, FSH, LH. finally ovulation and menstruation don’t take place.
why does fertility in women decline before disruptions in the menstrual cycle
progressive decline of inhibin B and AMH
effects of menopause on lower genital tract?
tissues undergo atrophy causing
vaginal dryness
dyspareunia
vulvar pruritis (dry itchy skin around vulva)
burning and discomfort
recurrent urogenital infections
vasomotor symptoms of menopause?
hot flushes
night sweats
cold sweats
heart palpitations
changes in blood pressure
