Menopause

Question 1

What are the Anterior pituitary gland functions

Answer 1

• controls activity of other endocrine glands
• stimulates production of oestrogen and progesterone
• ovulation and pregnancy in females
• testosterone production and spermatogenesis in males

Question 2

Which Hormones are produced in the pituitary gland?

Answer 2

FSH - follicle-stimulating hormone
LH - luteinizing hormone
PRL - prolactin

Question 3

What are the 4 Phases of the menstrual cycle?

Answer 3

1) menstrual phase
2) follicular phases
3) ovulation phases
4) luteal phase

Question 4

Which is the most potent type oestrogen?

Answer 4

17 B oestradiol

Question 5

What is the Genomic effect?

Which receptors are used?

Answer 5

ER a B nuclear receptors

Regulation of gene expression through the action of transcription factors

Question 6

What is the Non-genomic effect?

Which receptors are used?

Answer 6

Membrane G coupled receptors

Rapid action through the cascade of kinases
- eg: skeletal homeostasis
Lipid and carbohydrates metabolism
CVS
Electrolyte homeostasis

Question 7

What does oestrogen regulate?

Answer 7

Growth

# cellular division
# differentiation
# cellular and tissue functions in the body

They play a role in the maintenance and regulation of the female and male reproductive systems.

Question 8

What are the effects of oestrogens ?

Answer 8

Rapid effects of oestrogens don’t depend on a long process of mRNA and protein synthesis.

It relies on phosphorylation of the kinases (MAPK, ERK).

This can provide a rapid cellular response or indirectly regulate other genes expression

Question 9

What are Roles of oestrogens?

Answer 9

+ At puberty stimulates the growth of organs important for reproduction

+ stimulates cellular proliferation of glandular tissue and epithelial ciliated linings of fallopian tubes

+ stimulates bone growth

+ slightly increases whole body metabolic rates

+ increased fat deposition in the subcutaneous tissues

+ cause softening and better vascularisation off the skin

+ has an effect on sodium and water retention

Question 10

What is Perimenopause?

What age does it usually start?

Answer 10

It’s the time before the full cessation of the menstrual cycle

A natural transition towards the menopause

Oestrogen levels start to decrease ( from 300 msg per day to almost O )

Starts around 40 years and can last from a few months to a few years

Women can experience typical signs and symptoms of the menopause

Question 11

What are the Symptoms of perimenopause?

Answer 11

~ period changes
~ hot flushes and night sweats
~ mood changes
~ vaginal dryness
~ sleep problems
~ weight Changs

Question 12

Menopause definition

Answer 12

Menopause occurs when the women is not menstruating for 12 months - in most cases around the age of 50

It can be triggered by surgery such as hysterectomy or oophroectomy

Question 13

What is Primary ovarian insufficiency or premature ovarian failure (ROI)?

Answer 13

The loss of ovarian function in younger women
It’s not related to menopause but can cause similar symptoms

Including:
- irregular bleeding
- hot flushes
1 in 1000 under 30
1 per 100 under 40

Question 14

What are some Causes of POI?

Answer 14

• Surgical removal of ovaries
• cancer treatment
• autoimmune disease leg:m (DM type 1, Addisons)
• genetic ( eg related to X chromosome - turner syndrome or genetic predisposition).
• infections (mumps, TB)
• Environmental toxins leading to follicle depletion

Question 15

Menopause facts

Answer 15

The end of female reproduction activity

Starts with irregular often non- ovulatory menstrual cycles

Follicle supply is exhausted

Production of oestrogens decreases and no negative feedback occurs

Lack of oestrogens triggers physical changes

Question 16

Where can Oestrogen still be produced?

Answer 16

In low levels by the adrenal glands

Question 17

What are Changes to the ovaries after the menopause?

Answer 17

Architectural changes to the structure

Question 18

Which Changs happen to the uterus after the menopause?

Answer 18

Decrease in size of the uterus
The endometrium thins

Question 19

How does the Corpus - cervix ratio change after menopause?

Answer 19

Decreases

Part of the sonography post-menopausal assessment

Question 20

What are some of he Vaginal changes that occur after menopause?

Answer 20

The mucosal layer undergoes atrophy causing dryness and loss of elasticity

Question 21

What changes does the Menopause cause to bone?

Answer 21

The increased activity of osteoclasts (bone reabsorption) and very low activity of osteoblasts (bone production)

This leads to weaker bones and a risk of osteoporosis

Increased risk of vertebral, femur and hip fractures

Question 22

What are the Cardiovascular - vasomotor symptoms during the menopause?

Answer 22

Patient modulate the vasomotor tone of the blood vessels through its action on adrenaline and noradrenaline and release of nitric oxide (NO).

This process is unstable in menopause - increased adrenaline and noradrenaline release

The unstable flow of blood into the skin blood vessels leads to “hot flushes” , night sweats , cluster and tension headaches

Lack of oestrogen causes vasoconstriction of blood vessels. Combined with increases LDL levels there is a increased risk of cardiovascular disease

Question 23

What Metabolic changes occur related to menopause?

Answer 23

Lower BMR and ability to burn , increased LDL, lower HDL ( dyslipidemia) and increase deposition of central visceral fat leads to an increased risk of CVD and T2D as well as other metabolic disorders

Question 24

What Emotional Changes are related to the menopause?

Answer 24

• Insomnia leading to irritability and mood swings; feeling low
• feeling sadness and anxiety can lead to depression
• lack of motivation and difficulty concentrating
• fatigue
• brain fog

Question 25

Management of menopause symptoms - HRT

Answer 25

HRT - hormone replacement therapy (for upto 5 years only)

Oestrogen and progesterone for women both with and without a uterus.

Helps with the treatment of vasomotor symptoms, prevention of vaginal atrophy, improves The lipid profile and helps psychotropic mood changes

Question 26

What Risks are related to HRT?

Answer 26

Increased occurrence of some cancers eg: breast
DVT or thromboembolism

Question 27

Management of menopause symptoms - changes of lifestyle and diet

Answer 27

Manage with and fat deposition and prevents the development of metabolic diseases and protects blood vessels.

• increase exercise
• reduce alcohol
• reduce sugar and nicotine
• increase calcium, D3, bisphosphonates to inhibit osteoclasts action