Menopause

Question 1

Define menopause

Answer 1

• Permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity
• Need 12 consecutive months of no menstrual periods and no biological or physiological cause can be identified

Question 2

What is the average age of menstruation

Answer 2

50

Question 3

Define pathologic menopause

Answer 3

Gradual or abrupt cessation of menstruation before 40

Question 4

Describe the changes in hormonal level at menopause

Answer 4

• Oestrogen levels begin a gradual decline at 40 as the number of primordial follicles approaches zero
• When oestrogen levels fall below a critical level, then it fails to negatively feedback and therefore LH and FSH levels rise
  
  • FSH always higher than LH
• GnRH levels also rise at menopause due to no oestrogen feedback

Question 5

What hormone is measured to assess for menopause

Answer 5

• FSH levels are measured to determine if menopause has occurred
• Oestrogen not measured as oestrogen not only produced from the ovaries

Question 6

List some early signs of menopause

Answer 6

Hot flushes, sweating, insomnia, menstrual irregularity

• Frequent headache, mood swings, irritability, depression, insomnia
• Ovaries become smaller due to decreased oestrogen production (undergo atrophy)

Question 7

Describe why dysfunctional uterine bleeding occurs in menopause

Answer 7

• Continued oestrogen causes the endometrium to keep thickening
• Leads to a late menstrual period followed by irregular bleeding and spotting
• Greater thickening of uterine wall
• No ovulation means no corpus luteum and therefore no progesterone production
• Increased risk of carcinoma - unopposed oestrogen (progesterone acts to control uterine wall development from oestrogen)

Question 8

Why should oestrogen-only hormone therapy only be give to women who have had a hysterectomy

Answer 8

Women who have uterus have risk of developing uterine carcinoma due to unopposed oestrogen

Question 9

Describe some intermediate changes that occur after menopause

Answer 9

• Skin loses its elasticity and becomes thin and fine
• Weight increase - irregular food habit due to mood swings
  
  • Increased deposition of fat around hips, waist and buttocks
• Hair - dry and brittle
• Voice - become deeper due to thickening of vocal cords
• Digestive and urinary system
  
  • Digestive tract diminished after menopause
  • Urinary incontinence
• Breast - becomes flat and shriveled

Question 10

Describe some long term changes that occur after menopause

Answer 10

• Bone - calcium loss from the bone leads to loss of bone density
  
  • Oestrogen normally inhibits osteoclasts, therefore increased osteoclasts leads to increased recycling of bone
  • Predisposes to osteoporosis
• CVS system - increased circulating levels of lipids
  
  • Hyperlipidaemia can predispose to atherosclerosis
  • Gradual rise in the risk of heart disease and stroke

Question 11

Describe non-hormonal treatment for menopausal symptoms

Answer 11

• Dressing in light layers can alleviate hot flashes and night sweats
• Avoid caffeine, alcohol and spicy food
• Reducing dietary fat intake and regular exercise can reduce weight gain

Question 12

List advantages and disadvantages of hormone replacement therapy

Answer 12

• Advantages of HRT
  
  • Minimizes menopause symptoms
  • Improve well-being
  • Can limit osteoporosis
• Disadvantages of HRT
  
  • Increased risk of blood clots
  • Risk of heart disease
    
    • Risk of breast cancer