Week 3: Menopause Flashcards
(79 cards)
Question 1
How is menopause defined?
- 12 months of amenorrhea following the final menstrual period
- w/ no obvious pathologic cause
- Secondary to loss of ovarian follicular activity
Average age of menopause
51.4 years
What is perimenopause?
The transition from reproductive age to menopause
Perimenopause AKA
Menopausal transition
How long is perimenopause and when does it start?
On average, occurs ~4 years prior to the last menstrual period
Describe the hypothalamic-pituitary-ovarian axis in reproductive age women
Hypothalamus -GnRH-> anterior pituitary -LH & FSH-> Ovarian follicles -Estrogen & Inhibin-> increasing levels of Estrogen & Inhibin cause negative feeback to both the hypothalamus and the anterior pituitary
Describe the hypothalamic-pituitary-ovarian axis in perimenopause
Hypothalamus -GnRH-> Anterior Pituitary -LH & FSH-> Ovarian follicles -Estrogen & Inhibin-> increasing levels of Estrogen & Inhibin cause negative feeback to both the hypothalamus and the anterior pituitary
However, in perimenopause, the ability of the aging ovarian follicles granulosa cells of developing follicles to secrete inhibin decreases and so there is a decrease in negative feedback to the anterior pituitary resulting in an increase in FSH and Estrogen levels are maintained
The increase in FSH causes the follicular phase to shorten which causes the increase in Anovulatory cycles (abnormal uterine bleeding).
This causes accelerated loss of remaining ovarian follicles until depletion
With diminished ovarian follicles this results in depleted Estrogen production which further decreases negative feedback resulting in even higher GnRH, FSH and LH levels
How common are hot flashes in perimenopausal women
occurs in ~80%
Clinical presentation of hot flashes
- Sudden wave of heat that spreads over the body, particularly the upper body and face lasting 1-5 minutes
associated with:
- sweating
- palpitations
- anxiety
- sleep disturbances
Describe the role of menopause and cardiovascular disease
Decreased estrogen can affect the lipid profile which can increase LDL cholesterol and lead to cardiovascular disease
Etiology of hot flashes
secondary to dysfunction of the thermoregulatory nucleus of the hypothalamus which regulates sweating and vasodilatation to maintain body temperature within the thermal regulatory zone.
With women with hot flashes they have a narrower thermal regulatory zone due to changes in Estrogen, this means that minimal changes in body temperature can result in activation of the thermoregulatory nucleus of the hypothalamus
Explain how Estrogen levels influence body temperature regulation
It is hypothesized that a drop in estrogen increases neurotransmitter concentrations in the hypothalamus which creates a narrower thermoregulatory zone
In particular, NE and Serotonin have been shown to lower the thermoregulatory setpoint due to rapid fluctuations in estrogen levels or rapid estrogen withdrawal and not chronically low estrogen levels
Explain the mechanism of bone density changes in menopause
high risk within the first 10 years of menopause
Osteoblasts constanly lay down new bone while osteoclasts constantly resorb bone
Osteoblasts produce RANKL and OPG
RANKL binds to RANK on the surface Osteoclast progenitor cells leading to osteoclast development and bone resorption
OPG binds to RANKL which prevents it from binding with RANK and preventing osteoclast development and bone resorption
In menopause, with lower Estrogen RANKL production is greater than OPG production eading to increased bone resorption and is favored over bone deposition leading to long-term bone loss
Symptoms of perimenopause/menopause
- Hot flashes
- Bone loss
- Risk of cardiocascular disease
- vulvovaginal atrophy
- +++ more
Describe the mechanism of vulvovaginal atrophy in menopause
Symptoms of dryness, itching anddyspareunia
How does a drop in estrogen change the thermoregulatory zone to increase hot flashes?
It is hypothesized that a drop in estrogen increases neurotransmitter concentrations in the hypothalamus which creates a narrower thermoregulatory zone
What to expect with menopause?
- Hot flashes
- Bone density loss
- increased risk of cardiovascular disease
- vulvovaginal atrophy (dryness, itching, dysparenia)
- Incontinence & risk of recurrent UTIs
- Risk of mood distrubances including (new onset depression in the menopausal transition and sleep distrubances)
What is dyspareunia?
Painful intercourse
What is the mechanism of vulvovaginal atrophy in menopause?
- decreased estrogen results in thinning of the vaginal epithelium and loss of vaginal collagen in adipose tissue
- Loss of sebaceous glands on the vulva leads to increased dryness
- Vulva is also affected by narrowing of the vaginal introitus
- thinning of the epithelium of the lower urinary tract including the bladder and urethra increase risk of incontinence and can contribute to recurrent UTIs
Mechanism of mood disturbances in menopause
Increased risk of new onset depression and sleep distrubances
this is unclear if it is secondary to a decrease in estrogen or if it is 2o to menopausal symptoms
Options for treatment of menopause
Menopause hormone therapy
Benefits of menopausal hormone therapy
- The most efficacious treatment for hot flashes (75% reduction in hot flashes)
- Improves fracture rates
Considerations with menopausal hormone therapy
Be on the minimal dose for the shortest amount of time possible due to the increased risk associated with its use
For healthy women in their 50s the overall risk of complications is low
