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    lawrence agbortabi
    Changes at the end of a woman's reproductive life

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    MENOPAUSE

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    lawrence agbortabi
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    Changes at the end of a woman's reproductive life

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    Changes at the end of a woman's reproductive life

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    © All Rights Reserved
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    Download as docx, pdf, or txt
    2 views2 pages

    MENOPAUSE

    Uploaded by

    lawrence agbortabi
    Changes at the end of a woman's reproductive life

    Copyright:

    © All Rights Reserved
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    MENOPAUSE

    Menopause is a retrospective diagnosis and is defined as 12 months of amenorrhea. It is


    associated with the elevation of gonadotropins (FSH and LH). The mean age of 51 years is
    genetically determined and unaffected by pregnancies or use of steroid contraception.
    Smokers experience menopause up to two years earlier.
    • Premature menopause occurs age 30–40 and is mostly idiopathic, but can also occur
    after radiation therapy or surgical oophorectomy.
    • Premature ovarian failure occurs age <30 and may be associated with autoimmune
    disease or Y chromosome mosaicism.
    The etiology of menopausal symptoms is lack of estrogen.
    Clinical Findings.
    The majority of menopausal symptoms and signs are caused by a lack of estrogen.
    • Amenorrhea (most common symptom is secondary amenorrhea): menses typically
    become anovulatory and decrease during a period of 3–5 years known as perimenopause.
    • Hot flashes (75% of menopausal women): Unpredictable profuse sweating and sensation
    of heat, probably mediated through the hypothalamic thermoregulatory center.
    Obese women are less likely to undergo hot flashes, owing to peripheral conversion of
    androgens to estrone in their peripheral adipose tissues.
    • Reproductive tract. Low estrogen leads to decreased vaginal lubrication, increased
    vaginal pH, and increased vaginal infections.
    • Urinary tract. Low estrogen leads to increased urgency, frequency, nocturia, and urge
    incontinence.
    • Psychic. Low estrogen leads to mood alteration, emotional lability, sleep disorders,
    and depression.
    • Cardiovascular disease (most common cause of mortality (50%) in postmenopausal
    women). Prevalence rises rapidly after menopause.
    • Osteoporosis, a disorder of decreased bone density, leads to pathologic fractures when
    density falls below fracture threshold.
    Diagnosis. The laboratory diagnosis of menopause is made through serial identification of
    elevated gonadotropins(FSH and LH).
    Management
    Hormone Replacement Therapy
    There are both benefits and risks associated with hormone replacement therapy.
    • Estrogen therapy continues to be the most effective and FDA-approved method for relief of
    menopausal vasomotor symptoms (hot flashes), as well as genitourinary atrophy and
    dyspareunia.
    Estrogen can be administered by oral, transdermal, vaginal, or parenteral routes. All routes
    will
    yield the benefits described.
    • The most common current regimen is oral estrogen and progestin given continuously.
    • Women without a uterus can be given continuous estrogen.
    • All women with a uterus should also be given progestin therapy to prevent endometrial
    hyperplasia.
    Contraindications for hormone replacement therapy include personal history of an estrogen
    sensitive cancer (breast or endometrium), active liver disease, active thrombosis, or
    unexplained vaginal bleeding.
    • Benefits: Both HT and ET groups in WHI study had decreased osteoporotic fractures and
    lower rates of colorectal cancer.
    • Risks: Both HT and ET groups in WHI study were found to have small increases in deep
    vein thrombosis (DVT). The HT group also had increased heart attacks and breast
    cancer, but these were not increased in the ET group.

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