WK4: menopause and sexual dysfx

Hormonal changes during menopause

- During menopause FSH and LH will increase while progesterone and estradiol
decrease
- Waning levels of estradiol from granulosa cells
- First change in menopause is decreased Inhibin

Vasomotor instability: major disruption

- Hot flashing: subjective sensation of heat associated with cutaneous vasodilation and
decrease in core body temp that lasts 4 mins
- Cause:
o Dec thermal regulatory center in hypothalamus
o dec levels of estrogen rather than low estrogen
o serotonin and dopamine changes, LH surge
- Symptoms:
o Hot flashes, night sweats, moodiness, sleep disturbances and anxiety
o Can last for several years
- Tx:
o Dec alcohol, caffeine, relaxation technique
o SSRIs
o Estrogens are best treatment

Vulvovaginal Atrophy or GU syndrome

- Pruritus, dryness, burning, dyspareunia, post coital bleeding
- Cause:
o Waning levels of estrogen leads to inc basal and parabasal cell with dec
superficial cells
- Vaginal epithelium becomes thin and excoriated with diminished rugae
- pH of vag inc
- 84% women affected
- UTIs
- Estrogens are tx of choice, lubricants

Osteoporosis:
- Causes: Dec estrogens  greater osteoclastic activity than osteoblastic activity 
dec bone density and bone quality (micro architecture)
- Peak bone density in women is at age 18
- At menopause caucasian women loses 5% of bone mass per year for 5 yrs
o Untx  loose 50% of her bone mass in 20yrs
- 75% of bone loss is related to decreasing estrogens
- Symptoms:
o Vertebral fracture: pain, loss of ht, kyphosis, 50% of untx Caucasian women
over age of 65
o Women can lose 2.5 inches of their ht
o Colles: 15% risk in Caucasian women
 o Hip fracture: 80% associated with osteoporosis and survivors are often
severely disabled or invalids
o Tooth loss
- Modifiable risk factors:
o Dec estrogen
o Smoking
o Sedentary lifestyle
o Excess EtOH consumption
o Calcium and vitD
- Depression and fractures: SSRI
- Dx: Dual Energy absorptiometry (DEX) scan  over age 65
- Bone Mineral Density (BMD) of <-2.5 = osteoporosis
o Osteopenia = -1 to -2.5
- Tx:
o Dec tobacco and EtOH
o Wt bearing
o Inc Ca and Vit D
o Estrogens help prevent and treat osteoporis

Coronary Artery Disease

- Start estrogen before damage to endothelial cells

Dementia
- Start estrogens before damage to neurofibrillary tangles

Quality of life:
- After age 70: risk vs benefit ratio changes

Age at menopause
- Remained constant
- Life expectancy inc- 1/3 of life spent in menopause

Endometrial CA
- Unopposed estrogen can cause endometrial hyperplasia and cancer of endometrium
- Progestins will prevent endometrial cancer in women treated with estrogens

Sexual Dysfunction
- 60% atrophic vaginitis
- 20% PID and endometriosis
- 20% hypoactive sexual desire
- Vaginismus (anectodal experience)