9 Menopause

Question 1

Define menopause.

Answer 1

Permanent cessation of menstruation and end of reproductive life due to loss of ovarian follicular activity. No menstrual periods for 12 months ands no other biological and physiological cause can be identified

Question 2

What is the normal age range for menopause to occur?

Answer 2

45 and 55 (average is 50)

Question 3

What is pathological menopause?

Answer 3

Gradual or abrupt cessation of menstruation before 40 yrs (idiopathically) (eg premature ovarian failure)

Question 4

Give an example of what may cause surgical menopause

Answer 4

Removal of ovaries

Question 5

What are the 4 categories which menopause is broken down into?

Answer 5

1, Pre-menopause - 2, Peri-menopause, - 3, Menopause -4, Post-menopause

Question 6

What occurs during Pre-menopause? (Time prior to menopause)

Answer 6

From around 40yrs + Slightly less oestrogen secreted LH and FSH rise (FSH more) May be reduced fertility

Question 7

What occurs during Peri-menopause? (Transition phase) (Aka climacteric)

Answer 7

End of reproduction capacity Follicular phase shortens Ovulation early or absent

Question 8

What happens during the (menopause phase)

Answer 8

Permanent cessation of menstruation Ovarian follicular development

Question 9

What occurs during the post-menopausal phase?

Answer 9

Time after which women has experienced 12 consecutive month of amennorhea

Question 10

As the number of primordial follicles decreases throughout reproductive life, what happens to the production of oestrogen by the ovaries?

Answer 10

Oestrogen production falls

Question 11

What happens to the proportion of poor quality oocytes as the number of follicles decreases with age?

Answer 11

% of poor quality follicles increases

Question 12

In menopause both FSH and LH are raised due to the lack of negative feedback. Which of these is higher during menopause?

Answer 12

FSH higher than LH

As no inhibin (inhibin only acts on FSH)

Question 13

At a cellular level, what causes menopause?

Answer 13

Ovaries depleted of follicles

No amount of gonadotrophin stimulation can make them work

Oestrogen levels fall

FSH and LH rise

(No inhibin)

Question 14

What hormone is measured to diagnose physiological menopause?

Answer 14

FSH

Question 15

What are some of the symptoms of menopause?

Answer 15

• Hot flushes
• Itching
• Sweating
• Fatigue
• Bloating

Question 16

Why can menopause cause bloating?

Answer 16

Oestrogen helps with smooth muscles tone/definition

Loss of oestrogen- loss of smooth muscle tone

Question 17

What are some of the symptomatic consequences of oestrogen deficiency? (14)

Answer 17

Question 18

Menopause can cause dysfunctin in uterine bleeding. (eg spotting, heavier and longer periods etc). Explain why this is?

Answer 18

Changes in oestrogen

Can cause endometrium to keep thickening–> late period then spotting

No corpus luteum so no progesterone if no ovulation

Question 19

List some of the physiological symptoms that occur as a result of menopause.

Answer 19

Question 20

Name the enzyme that converts androgens to oestrogen in the ovaries and in adipose tissue.

Answer 20

Aromatase

Question 21

What happens to the size of the ovaries as a result of menopause?

Answer 21

Ovaries atrophy

Question 22

What changes might occur in a woman’s general appearance as a result of menopause? (4)

Answer 22

1. Skin
   
   1. loses elasticity- loss of elastin and collagen
2. Weight increase
   
   1. Irregular food habits
   2. Deposition of fat changes
3. Hair
   
   1. Drier and coarser
4. Voice
   
   1. Deeper- thickening of vocal cords

Question 23

Explain why menopause can cause constipation.

Answer 23

Motor activity of digestive tract diminished

Question 24

Why can menopause cause urinary incontinence and increased tendency to develop UTIs?

Answer 24

• Loss of oestrogen
  
  • Bladder and urethra tissue lining= thinner, drier, less elastic
  • Loss of pelvic tone

Question 25

What happens to the structure of the uterus, cervix and vagina as a result of menopause?

Answer 25

Uterus:

small and fibrotic

atrophy of muscles–>shrinkage of myometrium

regression of endometrium

Cervix:

Thinning- may be difficult to differentiate from vagina

Vagina:

Rugae lost

Question 26

What happens to the external genital organs as a result of menopause (vulva and breast)?

Answer 26

Vulva:

fat in labia majora and mons pubis decreases

pubic hair thins

Breast:

Thin women: flat and shrivelled

Heavy women: flabby and pendulous

Question 27

Why dos calcium loss from bones increase after the onset of menopause?

Answer 27

Reduced oestrogen- enhances osteoclast activity

Loss of bone density

Question 28

Why does the risk of heart disease and stroke increase after menopause?

Answer 28

Lack of oestrogen and progesterone

1. Increased cholesterol and lipid level in blood
2. Increased BP
3. Body weight increased and body fat distibution more central
4. Carbohydrate tolerance decreases
5. Insulin resistance increases, sensitivity decreases

Question 29

Useful:

Answer 29

Question 30

How can the symptoms of menopause be treated?

Answer 30

• Lifestyle modifications
  
  • Lighter layers
  • Control diet
  • More exercise
  • Avoid caffeine and alcohol
• HRT
  
  • Pill/patch/cream
    
    • Cream may help with tone- help with urinary incontinence
  • Limit osteoporosis

Question 31

What is it important to check for in patients who have post menopausal bleeding?

Answer 31

Endometrial carcinoma

Question 32

What are the risks of HRT?

Answer 32

Risks change with age and risks exponential

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