Menopause

Question 1

What age does menopause occur?

Answer 1

48-55

Question 2

How do we diagnose menopause?

Answer 2

It’s diagnosed after it happens. It’s a year after amenorrhea with high FSH levels.

Question 3

What are some factors that can cause a slightly earlier menopause? (Not premature ovarian failure)

Answer 3

Cigarette smoking, high fibre or vegetarian diet, low body mass index, type 1 diabetes, no previous pregnancies and genetics.

Question 4

Does the age of your first period and oral contraceptive use have anything to do with when you’ll start menopause?

Answer 4

Nope.

Question 5

How do we classify premature ovarian failure? (early menopause)

Answer 5

Cessation of menstruation before 40 years of age.

Question 6

What can cause premature ovarian failure?

Answer 6

Turner syndrome, fragile X syndrome, autoimmune disease or infection.

Question 7

What can cause induced or artificial menopause?

Answer 7

Pelvic radiation, chemotherapy, surgical removal of ovaries, and hysterectomy (despite intact ovaries)

Question 8

How long does perimenopause last? How do we diagnose it?

Answer 8

2-8 years. Irregular menstrual cycles and changes in hormones (increased FSH). Greater than or equal to 2 cycles missed and amenorrhea for greater than 60 days.

Question 9

What hormone is responsible for hot flashes, night sweats, and rapid decrease in bone density?

Answer 9

Estrogen

Question 10

The post menopause period is when there’s no menstrual cycles and menopausal symptoms diminish. What health problems are women prone to during this stage of life?

Answer 10

Osteoporosis, cancer, and heart disease

Question 11

What are the two primary forms of estrogen in a post menopausal woman?

Answer 11

Estrone (the dominant one made by adipose tissue)
and estradiol (from the adrenal gland)

Question 12

What’s different between early perimenopause and late perimenopause?

Answer 12

In early perimenopause you have changes in your cycle length - like >7 days. In late perimenopause you have 2 cycles that are skipped.

Question 13

What are the events of perimenopause?

Answer 13

1) Accelerated decrease in ovarian follicle number and ovary size
2) Initial increase in estradiol levels
3) Irregular menstrual cycle
4) Insufficient progesterone secretion
5) Final decrease in follicle number and estrogen production

Question 14

Why do FSH levels rise during perimenopause?

Answer 14

The ovaries become resistant to FSH so the pituitary increases FSH release to keep up with estrogen production which accelerates follicle recruitment and decreases follicular reserve.

Question 15

What happens to inhibin in perimenopause? What are the consequences of that?

Answer 15

Inhibin decreases which causes FSH to be released more because inhibin usually keeps FSH in check.

Question 16

How does increasing FSH impact estradiol?

Answer 16

It causes a hyperestrogenic state in initial stages of perimenopause, then estradiol levels greatly fluctuate as they decline.

Question 17

When perimenopause starts, 90% of women experience changes in three aspects to their cycle, what are they

Answer 17

1) Frequency of ovulation
2) Menstrual cycle length
3) Uterine bleeding - menstrual flow and frequency

Question 18

High levels of estrogen can cause thickened endometrium causing heavy long and unpredictable flow in mid cycle, it can also cause shortened menstrual cycles. What causes the shortened menstrual cycles?

Answer 18

Irregular duration of follicular phase and short menstrual cycles are due to positive feedback effects of estrogen and ovulation. It’s related to LH surge and ovulation happens more quickly.

Question 19

Women in perimenopause will have different changes in their follicular phase lengths and ovulation vs no ovulation. What are the combinations that frequently occur?

Answer 19

1) Short ovulatory cycle (short FP with ovulation)
2) Short anovulatory cycle (short FP with no ovulation)
3) Lengthened anovulatory cycles (long FP, no ovulation)

Question 20

Why do progesterone levels decrease when ovulation doesn’t occur?

Answer 20

1) Follicles only partially develop because of the irregular menstrual cycle causing fewer follicles to reach maturation
2) No corpus luteum is formed during anovulation cycles so progesterone doesn’t even try.

Question 21

Explain the estrogen dominance phase

Answer 21

Estrogen levels are declining, but not as quickly as progesterone. Estrogen is therefore unopposed during anovulatory cycles.

Question 22

What does estrogen dominance look like?

Answer 22

Abnormal periods, heavy bleeding and cramping, bloating, breast swelling, headaches, mood swings, weight gain, and hair loss. It’s also linked to uterine fibroids, fibrocystic breasts, PMS, and risk of breast cancer.

Question 23

What else can cause estrogen dominance?

Answer 23

Stress, excess body fat, liver impairment, and exposure to environmental agents like hormones in diary products, and pesticides.

Question 24

What is the state of hormones at the end of perimenopause?

Answer 24

1) Increased FSH and LH with no effect on ovaries
2) Sharp decrease in estrogen d/t loss of follicles
3) Progesterone stops after last menstrual period
4) Longer menstrual cycles until ovulation stops

FSH and LH high, Estrone, estradiol and progesterone low.

Question 25

After menopause, estrone is the dominant form of estrogen. What is its precursor and where is it made?

Answer 25

Androstenedione converts to estrone. It's made in stromal cells, adrenal cortex and adipose tissue. Cells that contain aromatase.

Question 26

What two hormones play a role in female libido?

Answer 26

Androstenedione and testosterone. They're made in the ovaries and adrenal glands. decline after one's 20's but continues to be made in adrenal glands and ovarian stromal cells but decreases by 50%.

Question 27

What causes hirsutism, virilism (masculinization) and defeminization during menopause?

Answer 27

A relative dominance of adrenal androgens like testosterone compared with estrogen.

Question 28

What are some functions of estrogen?

Answer 28

1) Mature female reproductive organs 2) Develop secondary sexual characteristics like fat distribution, body hair, etc. 3) Regulation of endometrial growth, ovulation and menstruation 4) Regulation of cervical and vaginal secretions during menstrual cycle 5) Growth and proliferation of ductal cells in breast tissue 6) Slows bone loss 7) Maintains condition of skin 8) Increases HDL levels, and increases hepatic LDL receptor synthesis 9) Increases synthesis of proteins by the liver (coags, transport proteins for thyroid) 10) stimulates arterial vasodilation 11) protects cognitive function and memory 12) Retains sodium and water during menstrual cycle.

Question 29

When do vasomotor symptoms like hot flashes and night sweats start?

Answer 29

Early perimenopause. 2nd most common symptom after irregular menstrual cycles.

Question 30

Why do we get hot flashes?

Answer 30

Estrogen declines, causing increased GnRH which causes our thermoregulatory check point goes down, so the body thinks it's too hot so it rapidly vasodilates causing hot flashes. Then you get too cold and get the chills.

Question 31

What can trigger hot flashes?

Answer 31

1) More frequent later in the day, hot weather, after ingesting hot foods, drinks, or emotional stress.

Question 32

What atrophies during menopause?

Answer 32

ovaries, uterus, vagina, cervix. Decreased vaginal and cervical secretions causing dyspareunia and decreased sexual desire. Decreased pH causes changes in bacterial flora and pruritis.

Question 33

Why do some menopausal women experience recurrent UTI's or incontinence?

Answer 33

Decreased urethral muscle tone and epithelium atrophy.

Question 34

What symptoms are expected in menopause?

Answer 34

1) Hot flashes/vasomotor changes 2) atrophy of sex organs 3) accelerated bone loss 4) decreased urethral muscle tone and epithelium atrophy 5) Thinning skin and more wrinkles d/t decrease in collagen 6) Loss of glandular tissue and increased fat and connective tissue causing changes in breast size and firmness 7) Mood swings 8) Increased blood cholesterol levels and increased risk of heart disease.