the physiology and regulation of menopause W10

Question 1

what is menopause?

Answer 1

permeant cessation of menstruation

Question 2

what does menstruation mark the end of?

Answer 2

reproductive competence

Question 3

how is menopause confirmed?

Answer 3

12 months of amenorrhea

Question 4

what does menopause occur as a result of?

Answer 4

menopause occurs due to loss of ovarian follicular activity and loss of ovarian hormonal function

Question 5

explain the loss of ovarian follicular activity during menopause

Answer 5

decrease in both quality and quantity of oocytes residing in ovarian follicles

Question 6

how may a postmenopausal woman get pregnant?

Answer 6

exogenous hormonal stimulation

Question 7

examples of iatrogenic menopause (secondary menopause)?

Answer 7

chemotherapy causing premature ovarian failure
surgical removal of both ovaries

Question 8

physiological symptoms of menopause - categories

Answer 8

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

Question 9

skin symptoms in menopause?

Answer 9

hot flashes
dryness
itching
thinning
tingling

Question 10

psychological symptoms in menopause?

Answer 10

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

Question 11

features of transitional menstruations

Answer 11

shorter or longer cycles
bleeding between periods

Question 12

long term sequelae of menopause

Answer 12

accelerated cognitive impairment
accelerated cardiovascular disease
autoimmune disease
infertility
osteoporosis

Question 13

average age of menopause?

Answer 13

51 years (typical range 45-55)

Question 14

what age range does abnormal menopause occur in?
what can this be due to?

Answer 14

under 40 years
primary ovarian insufficiency
premature ovarian failure

Question 15

factors affecting menopausal age?

Answer 15

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

Question 16

what hormones do postmenopausal ovaries produce

Answer 16

androstenedione and testosterone

Question 17

effect of androstenedione and testosterone in post-menopause?

Answer 17

converted to estrone in fat, muscle and skin. estrone is a weak form of estrogen

Question 18

what has high levels of estrone been linked to?

Answer 18

high levels of estrone has been linked to growth of breast and endometrial cancer

Question 19

recap of menstrual cycle endocrinology?

Answer 19

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

Question 20

what causes shorter cycle intervals in menopausal transition?

Answer 20

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

Question 21

what do falling estrogen, inhibin and AMH levels in menopause lead to

Answer 21

loss of negative feedback leading to increased GnRH, FSH, LH. finally ovulation and menstruation don’t take place.

Question 22

why does fertility in women decline before disruptions in the menstrual cycle

Answer 22

progressive decline of inhibin B and AMH

Question 23

effects of menopause on lower genital tract?

Answer 23

tissues undergo atrophy causing
vaginal dryness
dyspareunia
vulvar pruritis (dry itchy skin around vulva)
burning and discomfort
recurrent urogenital infections

Question 24

vasomotor symptoms of menopause?

Answer 24

hot flushes
night sweats
cold sweats
heart palpitations
changes in blood pressure

Question 25

types of management of menopausal symptoms?

Answer 25

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