What is menopause?
Menopause is the permanent cessation of menstruation (12 consecutive months), with no associated physiological causes, at the end of reproductive life due to loss of ovarian follicular activity
What is physiological menopause?
Physiologic menopause is the normal decline in ovarian function due to ageing (45 - 55), resulting in infrequent ovulation, decreased menstrual function and eventually cessation of menstruation
What is pathological menopause?
Pathological menopause is the gradual/abrupt cessation of menstruation < 40 years occur idiopathically (5% of women)
What are the 4 phases of menopause?
- Peri-menopausal (transition menopause)
- Post menopause
Describe 4 physiological features of the pre-menopause phase (peri-menopausal)
- Changes in menstrual cycle (follicular phase shortens, early/absent ovulation)
- Less oestrogen secreted
- LH & FSH levels rise
- Reduced fertility
What is observed in the perimenopause phase?
The perimenopausal phase is characterised by the physiological changes associated with the end of reproduction capacity and terminates with the completion of menopause
What is the post-menopausal phase?
The post-menopausal phase is the time after which a women has experienced 12 consecutive months of amenorrhea without period
In four steps, outline the concept of 'burning out the ovaries'
⇒ In reproductive life, ~400 primordial follicles grow & ovulate
⇒ At ~45 years old, only a few primordial follicles remain to be stimulated by FSH & LH
⇒ Production of oestrogen by ovaries decreases gradually
⇒ Inhibition gonadotrophins (FSH, LH) decreases
Which hormone is measured to diagnose physiological menopause?
FSH, not oestrogen because it arises from locations other than ovaries
Identify 5 early consequences of oestrogen deficiency
- Hot flushes
- Menstrual irregularity
- Psychological changes
Identify 5 intermediate consequences of oestrogen deficiency
- Vaginal atrophy
- Skin atrophy
- Stress urinary incontinence
Identify 3 late consequences of oestrogen deficiency
- Atherosclerosis (CVD & CHD)
- Alzheimer's disease
Describe the causes and treatment of hot flushes
- Hot flush occurs due to vascular changes and transient rises in skin temperature
- Relieved by oestrogen treatment
Explain why dysfunctional uterine bleeding occurs in the pre/perimenopause phases
- Continued oestrogen thickens endometrium (hyperplasia)
- No ovulation = no progesterone = no corpus luteum
Leads to a late menstrual period followed by irregular bleeding and spotting
How does dysfunctional uterine bleeding present?
- Spotting between cycles
- Extremely heavy bleeding
- Mid-cycle bleeding
- Longer, shorter / unpredictable lengths of time between periods
- Longer, shorter / unpredictable durations of periods
Describe the manifestations of the psychological changes in menopause
- Frequent headache
Describe the general changes in appearance which accompanies menopause
- Skin: loses its elasticity, becomes thin and fine due to loss of elastin and & collagen
- Weight: likely increase around hips, waist & buttocks due irregular food habit (mood swing)
- Hair: becomes dry, coarse (± hair loss due to oestrogen decrease)
- Voice: becomes deeper as vocal cords thicken (oestrogen decrease)
Why do menopausal women often present with constipation?
- Diminished motor activity of the entire GI tract
- Intestines tend to be sluggish
Why do menopausal women often present with urinary incontinence and UTIs?
- Oestrogen decrease results in the tissue lining the urethra and bladder becoming drier, thinner and less elastic
- Changes in bladder due to loss of pelvic tone
How do the internal genital organs change during menopause?
- Regression & shrinkage of endometrium
- Cervix becomes smaller & thinner and appears to flush with vagina, which loses its rugae
How do the external genital organs change during menopause?
- Vulva – decrease in fat in the labia majora & mons pubis
- Breast – flat and shrivelled (thin women) or remain flabby and pendulous (heavy women)
Why are post-menopausal women at high-risk of osteoporosis?
- Bone mass reduces by 2.5% per year for several years (Ca2+ moves out)
- Reduced oestrogen enhances osteoclast ability to absorb bone
Why is there a gradual rise in the risk of heart disease and stroke after menopause?
Lack of oestrogen and progesterone:
- Increases plasma cholesterol (hyperlipidemia)
- Increases in systolic and diastolic pressure (hypertension)
- Carbohydrate tolerance decreases (diabetes)
Outline the non-hormonal treatments of menopause
- Hot flushes & night sweats: dressing in light layers, avoid caffeine, alcohol and spicy foods
- Weight gain: lifestyle changes (dietary fat intake & exercise)
HRT is indicated in menopausal women to overcome the short-term and long- term consequences of oestrogen deficiency.
How can it be administered?
- Orally (pill form)
- Vaginally (as a cream)
- Transdermally (in patch form)
What are the possible disadvantages to HRT?
- Heart disease
- Mental decline
- Breast cancer
- Ovarian cancer
Why aren't oestrogen only preparations given to women who haven't had a hysterectomy?
Oestrogen causes endometrial proliferation outside the uterus, possibly causing endometrial cancer