Menarche, menopause and beyond (7.2)

Question 1

Outline the importance of the menarche and menopausal stages of female reproductive life

Answer 1

Menarche: Marks the physiological changes which allow for sexual reproduction. Changes in endocrine regulation

Menopause:Marks the end of ovarian function and fertility. Can be associated with a number of unpleasant side effects

Question 2

Describe the phases associated with the transition from reproductive stage to menopause and post-menopause

Answer 2

Question 3

Describe the clinical symptoms and changes that occur during the transition into menopause and post menopause

Answer 3

Hormonal: FSH and LH levels increase as females approach menopause and then remain high - due to _loss of negative feedbac_k from oestrogen. Oestradiol levels decrease approaching menopause and then remain low

Menstrual changes: Cycle length increases, with increased irregularity

Symptoms: Hot flashes, night sweats, vaginal dryness, sleep disturbances, mood symptoms, urinary, decreased libido, oesteoporosis, ↑ risk of CV disease, late transition phase can see short-term memory and learning impacted (restored after menopause), dry/thinner skin, acne, increased hair growth

Hot flashes (vasomotor symptoms) → waking at night

Vaginal dryness → dyspareunia

Urinary → Increased urgency and frequency

Question 4

Describe the endocrine changes occurring at menarche and menopause

Answer 4

Menarche

• Age of onset is approximately 13 y/o
• Increased pulsatile release of GnRH from the hypothalamus
• Oestradiol, FSH and LH levels rise
• High FSH and LH levels create negative feedback on the axis, leading to cyclic oestrogen changes
• Oestradiol associated positive feedback is not fully established and therefore ovulation rarely occurs
• Ovulatory cycles and uterine bleeding will vary in regularity until the axis has matured. May be irregular until 1 year following menarche

Menopause

• Decreased oestrogen levels
  
  • Also leads to decreased (pre-cursor) testosterone levels. Linked to decreased libido associated with menopause
• FSH and LH levels increase (due to loss of negative feedback from oestrogen)

Question 5

Outline the effects of early/late menarche and menopause

Answer 5

Menarche

Early:

Centripetal obesity, insulin resistance, glucose intolerance, CV risk, coronary heart disease, ↑ bone mineral density, ↑ cancer mortality

Late:

Osteoporosis, adolescent depression, social anxiety symptoms

Menopause

Early (< 40 y/o): Loss of fertility → psychological consequences; 2/3x ↑ risk of MI (oestrogen thought to maintain the flexibility of vessel walls); increased bone loss

Question 6

Describe the late reproductive STRAW +10 stage

Answer 6

Reduced probability of conceiving

Question 7

Describe the Early Menopausal Transition STRAW +10 stage

Answer 7

Menstrual cycle and endocrine changes

Cycle length increases by > 7 days

Question 8

Describe the Late Menopausal Transition STRAW +10 stage

Answer 8

> 2 missed cycles

> 60 days amenorrhoea

Can last for 1-3 years

Question 9

What ‘marks’ the end of the menopausal transition period?

Answer 9

The final menstrual period (FMP)

NOTE - this cannot be confirmed until 1 year following this

Question 10

Stage the estimated age of onset of the menopause

Answer 10

Average age: 51 years

Ranges from 45 - 55 y/o

Cannot be confirmed until 1 year following the FMP

Question 11

Describe the Early Menopausal STRAW +10 stage

Answer 11

FHS and oestradiol levels change

Most likely to see menopausal like symptoms

Persists for approximately 2 years

Question 12

Describe the Middle Menopausal STRAW +10 stage

Answer 12

High FSH and low oestradiol stabilise

Persists for 3-6 years

Question 13

Describe the Late Menopausal STRAW +10 stage

Answer 13

Limited reproductive endocrine stages

Stage persists until death