What are the health risks associated with menopause?
CVD (total LDL levels rise), osteoporosis, urogenital atrophy (pee issues), quality of life
What is the ave age of menopause in USA
52
What happens in ovarian development in week 4 of the fetus
- Appearance of primordial germ cells in yolk sac
- Migration of germ cells to genital ridge
- Germ cell mitosis
What happens in ovarian development in week 6 of the fetus
- Germ cells arrive at genital ridge
- Sex cord formation supports germ cells
What happens in ovarian development in week 8-12 of the fetus
- Ovarian differentiation
- Reproductive tract differentiation
- Initiation of meiosis
- oogonia become oocytes
- Meiotic arrest in P1
What happens in ovarian development in weeks 16-20 of the fetus
- Ovarian follicular formation
- Max oocyte number achieved (5-7 million)
What happens in the ovary in prepubescent state?
- Waves of follicular development and atresia
- No stimulation of ovary by pituitary gland
- Minimal estrogen production
- No ovulation occurs
How many germ cells does a female have by puberty?
300,000-500,000
About how many oocytes are selected to ovulate
400-500 (most undergo atresia)
Describe the rate of follicular atresia
Not fixed, becomes more rapid 10-15 years before menopause
Define menopause
The point in time when permanent cessation of menstruation occurs following the loss of ovarian activity (naturally or surgically)
- This is a retrospective diagnosis (12 mo w/o pd)
- FSH and LH are high, low estrogen
What is perimenopause
Time with menstrual irregularity and symptoms
What factors are related to age of onset of menopause
- Smoking dec age by 1.5yrs
- Family trends
- Dietary habits (veg younger than meat)
- Alcohol consumption and later
What is the health risks associated with perimenopause and post menopause?
metabolic syndrome
What are the menopausal symptoms?
Hot flash, urogential atrophy, muscoluskeletal symptoms, disordered sleep, mood (inc and exacerbated mood disorders)
What does smoking do to estrogen metabolism
Increases it! Thats why you hit menopause earlier and have more symptoms when you smoke
What are some risk factors for dev menopausal symptoms?
Smoking, african american, obesity
Treatment of menopausal symptoms
- Hormone replacement therapy
- SSRIs
- Antihypertensives
- Behavioral: diet, wt loss, dec smoking etc
What is the prev of premature ovarian insufficiency?
1%/year
What is premature ovarian insufficiency?
Cessation of ovarian fxn at or before 40y/o
How do you diagnose premature ovarian insufficiency?
High FSH/LH and concurrent low estradiol on two sep occasions at least 1 mo apart
Etiology of premature ovarian insufficiency?
- Genetics
- Autoimmune attack on ovaries
- Metabolic disorders
- Iatrogenic exposures (chemo etc)
- Smoking
Describe a genetic abnormality that leads to premature ovarian insufficiencey
Turner’s Syndrome, 45X–>premature ovarian failure and delayed puberty, both X chromosomes are req to be active in the ovary to ensure normal dev and maintenance of oocyte number. Get rapid atresia of oocytes.
Describe how chemo/radiation lead to premature ovarian insufficiencey
Effects of chemo/radiation depends on age of pt at time of exposure, treatment field, type, dose, duration
- Chemo causes damage to primordial follicles, alkylating agents are particularly damaging
- Radiation to the pelvis=more damaging due to scatter
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Male Histology11
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Female Histology39
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Menstrual Cycle42
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Male Gonad Physiology71
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Contraception45
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Abortion22
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Implantation and Placentation29
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Menopause26
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STIs and PID21
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Gynecologic Path 141
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Fertilization Mechansims17
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Polycystic Ovary Syndrome (PCOS)21
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Female Sex Hormones29
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Male Sex Hormones30
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GYN path 231
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Gyn path 3: Ovarian Cancer61
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Puberty55
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Fetal Pathology33
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Pathology of the Breast44
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Pathophys of Fetus and Placenta24
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Facts to know11
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Testicular Tumors29
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Congenital Mullarian Abnormalities6
