Lecture 10: Menopause

Question 1

What is menopause?

Answer 1

The permanent cessation of menstruation (the time when there has been no menstrual periods for 12 consecutive months and no other biological/physiological cause can be identified)

• part of a womans natural ageing process
• ovaries produce lower level of oestrogen and progesterone
• she is therefore unable to get pregnant

Question 2

What is the definition of climacteric?

Answer 2

Physiological period in a woman’s life during which there is regression of ovarian function

• may result in less periods
• no 12 month cessation yet

Question 3

What is the menopausal transition?

Answer 3

Time between onset of irregular menses and permanent cessation of menstrutation
-usually 4 years

Question 4

What is classed as early menopause?

Answer 4

Menopause that occurs under the age of 45

Question 5

What is premature menopause?

Answer 5

Cessation of menstruation due to depletion of ovarian follicles before the age of 40
-also called premature ovarian failure

Question 6

What is surgical menopause?

Answer 6

Permanent cessation of menstruation after bilateral oophorectomy

Question 7

When does physiological menopause usually occur?

Answer 7

Between the ages of 45-55 (average 50yo)

Question 8

What is pathological menopause?

Answer 8

The gradual or abrupt cessation of menstruation before 40 yo idiopathically

Question 9

What are the 4 categories in the menopausal phase?

Answer 9

1. Pre-menopausal: may be slight changes to FSH/LH levels but cycle is still relatively normal
2. Peri-menopausal: loss of oestrogen, causing increase in FSH and LH causing heavy/irregular periods
3. Menpause
4. Post menopause

Question 10

What happens in pre-menopause?

Answer 10

The time prior to menopause
-typically from ages 40+
-slightly less oestrogen secreted
-LH and FSH levels may rise (FSH more)
(may be reduced negative feedback)
-could result in some reduced fertility

Question 11

What happens in peri-menopause?

Answer 11

Termed the transition phase (climacteric)

• characterised by the physiological changes associated with the end of reproduction capacity
• follicular phase shortened
• ovulation can be early or absent
• this stage terminates with the completion of menopause

Question 12

What is post menopause?

Answer 12

Time after which a woman has experienced 12 consecutive months of amenorrhea

Question 13

How many possible oocytes do we have at menopause?

Answer 13

1000 possible oocytes

-quality of these are poor

Question 14

Explain the degeneration of ovarian function:

Answer 14

• 100,000s of ova develop
• in reproductive life roughly 400 of the primordial follicles grow into mature follicles and ovulate
• at 45 yo you only have a few primordial follicles that remain to be stimulated by FSH and LH
• production of oestrogen by ovaries decreases as the number of primordial follicles approaches zero
• when oestrogen production falls below a critical value, the oestrogens can no longer inhibit the production of FSH and LH (there is no productionof inhibin)

Question 15

What is the overall cause of menopause?

Answer 15

Occurs when the ovaries are totally depleted of follicles and no amount of stimulation from gonadotrophins can force them to work
i.e. primary ovarian failure

Question 16

Which hormone is measured to diagnose physiological menopause?

Answer 16

FSH

Question 17

What are some consequences of oestrogen deficiency?

Answer 17

Early: hot flushes (localised vasodilation), sweating, insomnia, menstrual irregularity, psychological symptoms
Intermediate: vaginal atrophy (smooth muscle), dyspareunia, skin atrophy, urge-stress incontinence (pelvic floor tone decreased)
Late: osteoporosis, atherosclerosis, coronary heart disease, cardiovascular disease, Alzheimer’s disease

All lead to reduced quality of life

Question 18

How can you treat hot flushes?

Answer 18

Can be relieved by oestrogen treatment

Question 19

Why do we get dysfunctional uterine bleeding in menopause?

Answer 19

• spotting between cycles
• extremely heavy bleeding
• mid-cycle bleeding
• longer/shorter/unpredicatble lengths of time b/w periods
• longer/shorter/unpredictable durations of period

Caused by changes in oestrogen (loss of hormonal control of this process)

• causes endometrium to keep thickening leading to a later menstrual period followed by irregular bleeding and spotting
• no corpus luteum= no progesterone
• increased risk of carcinoma

Question 20

What are some of the psychological changes in menopause?

Answer 20

-frequent headache
-irritability
-fatigue
-depression and insomnia
Likely due to loss of sleep due to night sweats
Diminished interest in sex due to emotional upset or secondary to painful intercourse due to dry vagina

Question 21

What are the changes to the ovary in menopause?

Answer 21

• ovaries become smaller (atrophic)
• oestrogen production decreases
• androgens will still be produced which can be converted to oestrogen via aromatase

Question 22

What are the changes in general appearance in menopause?

Answer 22

Lots of these are due to decreased muscle tone

Skin: loses elasticity, becomes thin and fine, due to loss of elastin and collagen from skin

Weight: increase, result of irregular food habit due to mood swings, more deposition around hips, waist and buttocks

Hair: dry and coarse, may be hair loss due to low level of oestrogen

Voice: becomes deeper due to thickening of vocal cords

Question 23

How does menopause affect the GI and urinary systems? (due to loss of oestrogen)

Answer 23

GI: activity of digestive tract is diminished due to loss of muscle tone, intestines tend to be sluggish resulting in constipation

Urinary system: tissue lining urethra and bladder become drier, thinner and less elastic

• changes in bladder
• loss of pelvic tone
• urinary incontinence (treat by oestrogen only as progesterone relaxes ligaments)
• increased frequency of passing urine
• increased tendency to develop UTI

Question 24

How is the uterus affected by menopause?

Answer 24

• uterus becomes small and fibrotic due to atrophy of muscles
• regression of endometrium
• shrinkage of myometrium
• cervix becomes smaller and becomes closer to the vagina so in older women the cervix is very difficult to indentify from the vagina
• vaginal rugae lost

Question 25

What are some external genital changes in menopause?

Answer 25

Vulva: fat in labia majora and mons pubis decreases and pubic hair becomes sparse
Breasts: in thin built woman the breasts become flat and shrivelled, in heavy built woman they remian flabby and pendulous

Question 26

How does menopause affect bone?

Answer 26

Loss of bone density: as calcium loss from bone is increased in the first 5 years after menopause
-calcium moves out of bone leaving them weak and liable to fracture
-reduced oestrogen enhances the osteoclast ability to absorb bone
=osteoporosis

-can be limited by oestrogen therapy

Question 27

How does menopause affect the cardiovascular system?

Answer 27

Biggest killer of post-menopausal women

• see cardiovascular disease onset
• changes to metabolism (accumulation of fatty deposits, increased cholesterol level in blood, hyperlipidemia)
• rise in risk of heart disease and stroke

Question 28

How does menopause affect the cardiovascular system?

Answer 28

Biggest killer of post-menopausal women

• see cardiovascular disease onset
• changes to metabolism (accumulation of fatty deposits, increased cholesterol level in blood, hyperlipidemia)
• less tone in vascular walls
• rise in risk of heart disease and stroke

Question 29

What are some theraputic interventions to menopause?

Answer 29

Non-hormonal

• dressing in light layers can alleviate hot flashes/sweats or avoiding caffiene, alcohol and spicy foods
• reducing dietary fat intake and regular exercise to combat weight gain

HRT (hormone replacement therapy)
-in pill form, vaginally (as cream), trans-dermally (patch form)