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Reproductive systems > Menopause > Flashcards

Menopause Flashcards

1
Q

What is the menopause?

A
  • Permanent cessation of menstruation resulting from loss of ovarian follicular activity
  • Recognised to have occurred after 12 consecutive months of amenorrhoea without pathological or physiological cause
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2
Q

What is climacteric?

A
  • Physiological period in a woman’s life during which there is regression of ovarian function
  • Perimenopause
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3
Q

What is menopausal transition?

A
  • Time between onset of irregular menses and permanent cessation of menstruation
  • Around 4 years long
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4
Q

What is early menopause?

A
  • Menopause occurring under age of 45
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5
Q

What is premature menopause?

A
  • Cessation of menstruation due to depletion of ovarian follicles before age of 40
  • Also called premature ovarian failure
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6
Q

What is physiologic menopause?

A
  • Normal decline in ovarian function due to aging
  • Begins in most women between ages 45 and 55
  • Average age 51
  • Results in infrequent ovulation
  • Decreased menstrual function
  • Eventual cessation of menstruation
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7
Q

What are the 4 phases of menopause?

A
  1. Pre-menopause - slight changes to FSH/LH levels but cycle relatively normal
  2. Peri-menopausal - cycle disrupted
  3. Menopause
  4. Post-menopause
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8
Q

Outline the pre-menopause phase

A
  • Time prior to menopause
  • Typically from age 40+
  • Slight reduction in oestrogen
  • LH and FSH levels may rise; FSH rises more
  • May be reduced negative feedback
  • Fertility potentially reduced
  • Cycles can remain relatively normal
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9
Q

Outline the perimenopause phase

A
  • Transition phase
  • Physiological changes characterise phase
  • Follicular phase shortens
  • Ovulation early or absent
  • Terminating with completion of menopause
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10
Q

Outline the menopause phase

A
  • Permanent cessation of menstruation
  • Caused by ovarian follicular development failure
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11
Q

Outline the post-menopause phase

A
  • Time after which a woman has experienced 12 consecutive months of amenorrhoea
  • FSH levels stabilise in early post-menopause
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12
Q

How many primordial follicles mature and ovulate?

A
  • 100 000s of ova degenerate leaving ~400 follicles that can mature and complete ovulation
  • By ~45 years old only a few follicles remain to be stimulated by FSH and LH
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13
Q

What happens as we get closer to having 0 primordial follicles left?

A
  • Oestrogen production by ovaries decreases
  • When oestrogen production falls below a critical value, it can no longer inhibit production of LH/FSH
  • See a rise in LH and FSH production
  • FSH increases more due to lack of inhibin
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14
Q

When do we use an FSH to diagnose women with menopause?

A
  • If woman is aged 40-45 years with menopausal symptoms
  • If woman is under 40 years old in whom menopause is suspected
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15
Q

When would we diagnose premature ovarian insufficiency?

A
  • Diagnose premature ovarian insufficiency in women <40 years
  • If menopausal symptoms and elevated FSH levels on 2 blood samples taken 4-6 weeks apart
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16
Q

What are the symptoms of menopause?

A
  • Vasomotor symptoms - hot flushes and night sweats
  • Change to menstrual pattern
  • Cognitive impairment and mood disorders
  • Urogenital symptoms
  • Altered sex function
  • Sleep disturbance
  • Skin and hair changes
  • Joint and muscle pain
  • Fatigue
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17
Q

Explain the vasomotor symptoms of menopause in further detail

A
  • Hypothalamic origin due to pulsatile release of GnRH
  • Affects ~80% of women
  • Hot flushes especially at night
  • Can last from a few months up to more than 5 years
  • In 90% of cases exogenous oestrogen or progesterone will relieve symptoms
18
Q

What changes to the menstrual pattern are caused by menopause?

A
  • Dysfunction in uterine bleeding such as:
  • Spotting between periods
  • Heavy bleeding
  • Mid-cycle bleeding
  • Irregular cycles
19
Q

What causes changes to the menstrual pattern in menopause?

A
  • Changes in oestrogen
  • Causes hyperplasia of endometrium
  • Leads to a late menstrual period followed by irregular bleeding/spotting
  • No corpus luteum so no progesterone
  • Unopposed oestrogen = increased risk of carcinoma
20
Q

Give examples of psychological changes noticed in menopausal women

A
  • Irritability
  • Confusion
  • Lethargy
  • Memory loss
  • Loss of libido
  • Depression
21
Q

How does the skin change during menopause?

A
  • Loses elasticity
  • Becomes thin and fine
  • Loss of elastin and collagen
22
Q

How does weight change during menopause?

A
  • Weight increase
  • Likely to be due to irregular food habit due to mood changes
  • More deposition of fat around hips, waist and buttocks
23
Q

How does hair change due to menopause?

A
  • Becomes dry and coarse
  • Hair loss may occur due to decreasing oestrogen level
24
Q

How does the voice change due to menopause?

A
  • Becomes deeper
  • Due to thickening of vocal cords
25
Q

How does menopause affect the GI tract?

A
  • Diminished motor activity of entire GI tract
  • Sluggish intestines lead to constipation
26
Q

How is the urinary system affected by menopause?

A
  • Tissue lining urethra and bladder becomes drier, thinner and less elastic
  • Loss of pelvic tone
  • Urinary incontinence
  • Reduced elasticity of bladder (urinary frequency and urgency, nocturia, dysuria)
  • Increased susceptibility to UTIs
27
Q

What changes occur in the genital organs due to menopause?

A
  • Absence of oestrogen causes: thinning of vaginal skin (dyspareunia and bleeding) and lack of glycogen (rise in vaginal pH)
    -Treat with topical oestrogens
  • Uterus can become small and fibrotic due to atrophy of muscles
  • Regression of endometrium
  • Shrinkage of myometrium
  • Thinning of cervix
28
Q

How do the breasts change after menopause?

A
  • Decreased fat and tissue in breasts
  • Mammary gland tissue shrinks
  • Breasts begin to sag as connective tissues lose elasticity
29
Q

How do the bones change as a result of menopause?

A
  • In first 5 years after menopause, Ca2+ loss from bones causes loss in bone density
  • Bone mass reduces by 2.5% per year for several years
  • Reduced oestrogen enhances osteoclast ability to resorb bone
  • Can lead to osteoporosis and risk of fragility fractures
30
Q

How can we reduce risk of osteoporotic fracture in younger post-menopausal women?

A
  • HRT
31
Q

How does menopause affect the cardiovascular system?

A
  • Risk of CHD is increased significantly
  • Potentially due to withdrawal of protective effect of oestrogen
  • Menopause leads to obesity, hypertension and dyslipidaemia (LDL and VLDL cholesterol increases)
32
Q

What is the conservative management for symptoms of the menopause?

A
  • Regular exercise
  • Wear light-weight clothing for sleep
  • Sleep in a cooler room
  • Avoid triggers: spicy food, caffeine, smoking, alcohol etc
  • Contraceptive advice
33
Q

How can the vasomotor or mood disorders that accompany menopause be treated?

A
  • Offer oral or transdermal HRT
  • Combined oestrogen and progesterone if woman has a uterus
  • Oestrogen alone if she does not have a uterus
34
Q

Why do women with uteruses have combined oestrogen and progesterone HRT?

A
  • Progesterone protects endometrium from hyperplasia
35
Q

How are the urogenital symptoms of menopause treated?

A
  • Low-dose vaginal oestrogen
36
Q

What are the benefits of HRT?

A
  • Reduction in vasomotor symptoms
  • Improvement in mood changes
  • Improvement of urogenital symptoms
  • Reduction in osteoporosis risk
  • Lower risk of colorectal cancer
  • Maintains and enhances muscle mass
  • Quality of life improves
37
Q

What are the risks of HRT?

A
  • Venous thromboembolism associated with oral HRT
  • HRT tablets slightly raise risk of stroke
  • Oestrogen and progesterone HRT may increase breast cancer risk
38
Q

What are the advantages and disadvantages of oral HRT?

A
  • Cheap and effective
  • Higher doses required as it enters first pass metabolism
39
Q

What are the advantages and disadvantages of transdermal HRT?

A
  • Avoids first-pass metabolism
  • Reduces risk of venous thromboembolism
  • Continuous administration
  • Cost
  • Skin reactions
40
Q

What are the advantages and disadvantages of vaginal HRT?

A
  • Good for urogenital symptoms
  • Minimal systemic absorption
  • Can be used for 3 months without progesterone opposition
  • Unlikely to treat other symptoms
41
Q

What are the advantages and disadvantages of mirena intrauterine system as HRT?

A
  • Can be used for 4 years to provide progesterone arm of HRT contraceptive
  • Only provides progesterone - pt will still need oestrogen

Reproductive systems (20 decks)

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