Ovarian failure/menopause Flashcards
(45 cards)
Natural menopause definition
permanent loss of ovarian follicular activity
12 consecutive mo of amenorrhea
no other obvious pathologic/physiologic cause
avg age 51
Perimenopause definition
time prior to menopause and 1st year after menopause
Induced menopause definition
cessation of menstruation due to surgical removal of ovaries
OR iatrogenic ablation (chemo/radio)
Premature menopause/POI definition
menopause occurs >2 SD below mean age
FSH > 30 mIU/mL x 2 at least 1 mo apart
amenorrhea > 4 mo
preceded with a duration of disordered menses
Pathophysiology of menopause
depletion of ovarian follicles
reduced inhibin due to low FSH
increased activin - increases with reduced inhibin, tries to increase FSH
high FSH/LH
low Estrogen - dysfunctional granulosa cells
low progesterone
low androgen levels
Menopause symptoms
headaches/hot flashes teeth loosen, gums recede nipples become smaller and flatten breasts droop and flatten skin becomes drier, develops rougher texture backaches risk of CV disease abdomen loses muscle tone vaginal dryness, itching, shrinking stress/urge incontinence
Issues involved in ovarian failure
menstrual changes vasomotor symptoms urogenital changes mood changes sexual changes CVD bone health
Menopause - menstrual changes
Cycles initially get shorter before longer
- rapid follicular recruitment
- initially loop cycle: Luteal Out Of Phase follicular event (short)
- then lag cycles (long)
AUB
Depletion in primordial follicles
amenorrhea eventually occurs
LOOP cycle
Luteal Out Of Phase follicular event
premature formation of a follicle due to major surge in FSH during luteal phase
Lag cycles
Long follicular phase with aberrant folliculogenesis
high E2, low P4
Vasomotor symptoms during menopause
Hot flashes/night sweats
sudden onset - begins in chest, may progress to neck/face
often associated with anxiety, palpitations and sweating
can interfere significantly with life
75-80% of women experience them
generally from 6 mo - 5 y, but can last as long as 15 years
can occur in perimenopause
Etiology of vasomotor symptoms during menopause
Estrogen withdrawal --> Dysregulation of firing rate of thermosensitive neurons in preoptic hypothalamus decreased alpha2 activity significantly smaller thermoneutral zone
Management of vasomotor symptoms during menopause
Lifestyle - cool rooms, regular exercise, stop smoking
HT: estrogen alone or with progestin - lowest dose for shortest duration
Non-hormonal therapy: clonidine alpha 2 agonist
gabapentin
SSRI
Stellate ganglion block
Non-Rx - controversial, vitamin E??
Urogenical consequences of menopause
vaginal atrophy
UTI
incontinence
pelvic prolapse
Atrophy of urogenital epithelium and subepithelial tissues
Degeneration of collagen, elastin, sm
decreased blood flow to tissues
Estrogen-sensitive pelvic tissues
receptors found in: Introitus vagina bladder urethra pelvic floor musculature
Vaginal atrophy (menopause)
DYspareunia
vaginal dryness
itching
irritation
Pathophysiology of vaginal atrophy
thinning of epithelium less blood flow vaginal length/diameter shrink nerve endings exposed increased trauma
UTI during menopause pathophys
mucosa is thinner
glycogen production declines
decreasing level of lactobacilli
reduced lactic acid production
Urinary incontinence during menopause pathophys
reduction in mean uretrhal closure pressure
thinning of bladder mucosa and increased irritation
increased likelihood of urinary incontinence
Mood changes during menopause
some evidence for increased irritability, tearfulness, anxiety, poor concentration
secondary to - ??
- fluctuating E levels (E has positive effects on serotonin activity, upregulation of 5-HT1 receptors, decreased MOA activity)
- sleep disturbance
Depression during menopause
Risk factors:
- Hx of depressive disorders
- poor physical health
- Life stressors
- Hx of surgical menopause
- Long transition
Sexual concerns during menopause
Lack of E: dyspareunia, decreased vaginal blood flow, altered sesation
Reduction in ovarian testosterone
AUB is problematic
depressive symptoms
Managing sexual concerns during menopause
Address interpersonal/contextual components
Address biologic factors (AUB, vaginal atrophy, mood/anxiety)
Routine evaluation of hormone - limited value
testosterone therapy by experienced physicians
CVD during menopause
women who have had oophorectomy: higher age adjusted risk than those with intact ovaries
Adjusting for age, postmenopaulsa women - 2x risk seen in premenopausal
Less favourable lipid profiles
increased insulin resistance
increased likelihood of thrombosis
HT no longer indicated
