Session 5- The Patient in Menopause

Question 1

what is menopause

Answer 1

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

Question 2

average age of women starting menopause

Answer 2

50

45-55

Question 3

what happens during pre-menopause

Answer 3

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.

Question 4

why does FSH rise higher in pre menopause

Answer 4

FSH will rise more than LH because of the removal of inhibin on the HPG axis

Question 5

what happens during peri-menopause

Answer 5

the transition phase where additional physiological changes occur such a s mood swings and hot flushes leading ultimately to greater infrequency of menstruatiion

Question 6

what happens during menopause

Answer 6

this is when there has been a complete cessation of menstrual periods for 12 months

Question 7

what happens during post menopause

Answer 7

when there are no follicles left and she is no longer able to concieve

Question 8

what bone disease can menopause lead to

Answer 8

reducing levels of oestrogen enhance osteoclast activity because normally oestrogen inhibits osteoclasts

• more bone is absorbed
• increased calcium loss from bone

OSTEOPOROSIS

Question 9

Oestrogen and the CVS system

Answer 9

low levels of oestrogen and progesterone cause changes in the lipid profile in postmenopausal women. Increased circulating lipid levels

risk of - atherosclerosis stroke, MI

Question 10

Non-hormonal management of menopause

Answer 10

this relates to general lifestule advice that can help with vasomotor symptoms and dietary advice to reduce weight gain and CVS risk

Question 11

hormonal management of Menopause

Answer 11

this involves replacing oestrogen. The main inidication for HRT are to help manage the symptoms related to low levels of oestrgen

Question 12

how do oocyte change with age

Answer 12

they quality and quantity goes down

Question 13

what do we measure to diagnose menopause

Answer 13

FSH

oestrigen is too low or absent so cant measure that

Question 14

physiological symtoms of menopause

Answer 14

itching
restless limbs
change in body temp
sleep changes
bloating
mood changes and forgetfulness

Question 15

what causes the hot flushes

Answer 15

loss of oestrogen

Question 16

what changes happen to the ovary in menopause

Answer 16

the ovaries become smaller

-oestrogen production decreases

Question 17

how does lack of oestrogen affect the urogenital mucosa

Answer 17

lack of collagen synthesis and bloof low in vaginal epithelium and glycogen production - vaginal pH goes up

• increase dryness
• increase irrtation
• increase infection

Question 18

how does menopause affect the GI system

Answer 18

motor activity of the entire digestive tract is diminished after menopause
-the intestines tend to be sluggish resulting in constipation

Question 19

how does menopause affect the urinary system

Answer 19

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

Question 20

How does the uterus change in menopause

Answer 20

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

Question 21

how do the external genital organs change

Answer 21

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