Menopause Flashcards
What is the average age for menopause?
when may it occur earlier?
- average age in UK is 51, but it can occur any time between 45-55
- in some women it may occur earlier due to conditions and treatments such as BSO, hysterectomy, chemoradiotherapy etc
In premenopausal women, ovaries are controlled by FSH and LH which are modulated by neg feedback of estradiol and progesterone and inhibin B
What is the underlying physiology of menopause?
What represents ovarian reserve
W age, ovaries become less responsive to LH, FSH. Therefore Less oocytes developed, so oestrogen and progesterone levels decrease
In response to decreased androgens, FSH and LH secretion by increases in an attempt to stimulate the ovaries to produce more estrogen and progesterone. However, due to the decreased responsiveness of the ovaries, hormone production continues to decline
inhibin B + AMH represent ovarian reserve, so w time, the ovarian follicles become anovulatory + follicle development stops
What happens to circulating androgen levels during menopause?
Circulating E2 drops dramatically
Oestrogen is produced by aromatisation of testosterone peripherally
Ovaries produce testosterone post-menopausally & some testosterone is produced by adrenal glands.
Small amounts of pg produced by ovaries and adrenal glands.
So, still circulating hormones but in much lower levels
What do we measure clinically to indicate menopause?
What other things increase and decrease?
Clinically we measure FSH bc a rise in FSH indicates menopause
LH increases later in menopause
AMH levels= 1st sign of declining ovarian function - we don’t really measure this routinely
Inhibin B declines ~2yrs before FMP (final menstrual period)
Oestrogen & pg levels fall close to the menopause
Adrenal & ovarian androgens decline from age 20 but not related to menopause
How is menopause diagnosed in younger vs older women?
In women <45: history
Endocrine hormone levels: FSH, LH, oestradiol - to confirm diagnosis and exclude correctable causes
In women over 45 years of age: history
No point in measuring FSH because in perimenopause, FSH levels will fluctuate - so use a history
What are the 3 stages of menopause?
Perimenopause:
- Transition phase leading up to the final period - Occurs when hormone levels in the body begin to fluctuate and then decline
- Periods become irregular, women may develop menopausal symptoms
- Can last up to 10 years
- Fertility decreases
Menopause: diagnosed 12 months after the last period
Postmenopause: time after menopause has occurred
2 consequences of loss of ovarian oestrogen production during menopause?
- age related co-morbidities (CVD, osteopenia/porosis, type 2 DM, dementia)
- menopause associated w increased risk of metabolic syndrome (central obesity, insulin resistance, hypertension, altered lipid metabolism)
Remember- oestrogen exhibits a beneficial and protective effect against CVD and loss of bone mineral density
What are the symptoms of menopause?
how many have vasomotor symps., average duration of symps, how long can GU syndrome last?
- May start several years before menopause
- Average duration of symptoms around 5-7 years
- GU syndrome of menopause can continue for a long time post-menopause
Hot flushes, night sweats, disrupted sleep, aches and pains, brain fog, mood disturbance (feeling low, anxiety), vulvovaginal/urinary
CVD & menopause
2 specific risk factors, how does CVD present in women vs Men, why are premenopausalCVD rates lower in women?
Women have specific risk factors for CVD:
- oestrogen depletion
- pregnancy comps → pre-eclampsia, diabetes, HTN
CVD presents diff in women too - most women won’t have chest pain on exertion, instead have smaller artery malfunction - but still may have chest pain at rest
Oestrogen affects endothelial wall & sm function, lowers LDL and increases HDL
Also stimulates NO + prostacyclin release–> vasodilation
Bone health in postmenopausal women?
what can help prevent bone loss?
Oestrogen promotes osteoblastic activity - therefore fall in estrogen causes increased bone resorption- increasing osteoporosis risk
Agents that reduce bone turnover to premenopausal levels (e.g. estrogens, bisphosphonates, SERMs) have been shown to prevent bone loss and, in women with OP, to reduce fracture risk
4 consequences of metabolic syndrome/obesity in midlife?
What kind of weight change is seen in menopause?
- increased risk of CVD inc CAD, HTN, stroke
- increased risk of breast, uterine and colon cancer
- increased likelihood of depression and sexual dysfunction
*mostly increase in central adiposity during menopause
What causes the GU symptoms of menopause?
What are the GU symptoms of menopause?
Oestrogen receptors are widespread - therefore If oestrogen decreases: epithelium tissue gets thinner & drier, has diminished blood flow, reduced elasticity. This can cause:
- dryness, irritation, itching & pain during sex
- urinary symptoms such as dysuria, frequency, UTIs
- increased risk of infections due to mucosal disruption & vaginal atrophy which alters the vaginal microbiota
Describe early and premature menopause + reasons for these?
what is premature menopause that occurs spontaneously?
early = between 40-45 years (5% of women)
Premature occurs before the age of 40 (1% of women). Reasons:
- no identifiable reason.
- genetic, environmental reasons
- AI disease or viral infections
- BSO, hysterectomy, chemo/ radiotherapy
Premature menopause that occurs spontaneously is called primary ovarian insufficiency, or POI
consequences of early and premature menopause?
what should women with premature menopausebe advised to take & until when?
A management of menopause is health promotion- expand on this
- Keep weight within a health range, BMI of 18.5-25kg/m2
- Smoking cessation, Alcohol <2units/day
- Adopt a Mediterranean style diet
- 150 minutes of exercise into a weekly routine
- Kegels
- Adequate calcium + vitamin D intake
- Participate in the national cancer screening programmes: cervix, breast and colorectal
5 different HRT formulations?
What are the alternatives to HRT in treating menopause
non-hormonal vs non-pharmaceuticals vs Behavioural therapies
- Hot flushes are common menopausal symptoms. How many women experience them?
A. 100%
B. 75%
C. 50%
D. 30% - Which of theses statements is true?
A. Hot flushes stop when your periods stop
B. Hot flushes may continue for several years
C. HRT is the most effective treatment
D. B and C - Which blood test can help confirm if a woman is beginning menopause
A. Follicle stimulating hormone (FSH)
B. Oestrogen
C. Progesterone
D. B&C - What is the most serious adverse effect of menopause?
A. Hot flashes
B. Osteoporosis
C. Heart disease
D. B and C - How much bone loss does a woman experience in the first 5 years of menopause?
A. Around 10%
B. 2-5%
C. About 25%
D. About 35% - Hormone therapy eases some of the negative effects of menopause. Which of theses
hormones are used in women who have had a hysterectomy?
A. Oestrogen
B. Oestrogen and progesterone
C. Testosterone
D. Prostaglandin
B, D, A, D, A, A
