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Physiology of Menopause
Physiology of Menopause
Menopause
Menopause :Perminent cessation of menstruation caused by
failure of ovarian follicular development in the
presence of adequate gonadotrophin stimulation.
Climacteric :The physiologic period in a women's life during
which there is regression of ovarian function.
Premature ovarian failure :Cessation of menstruation due to depletion of
ovarian follicles before the age of 40y.
Menopause
Menopause Age
Median - 51, range of 47-55 yrs
Median for perimenopause - 47 years, median length of 4
years
Premature menopause -caused by genetic abnormalities on
the long and short arm of X chromosome
Earlier menopause:
surgical causation (30%)
family history of early menopause
cigarette smoking
precocious puberty
left-handedness
Later age :
obesity
higher socioeconomic class
Types of Menopause
Physiologic menopause
Iatrogenic menopause :Surgical, radiation therapy
,chemotherapy, infection and tumer
Ovarian Dysfunction
Women are born with about 1.5 million ova
At menarche 400,000 ova
Most women menstruate about 400 times
between menarche & menopause
With menopause, the ovary is no longer
capable of responding to pituitary
gonadotropins production of estrogen
&progesterone
Physiology of Menopause
Ovarian dysfunction
Few remaining follicular units present
but those are no longer capable of
normal response despite stimulation
by marked of gonadotropins.
OVARIAN DYSFUNCTION
Degeneration of granulosa & thica cells
Estrogen
FSH & LH
Con.
Estrogen :
In preimenpausal women ,the main
Estrogen is E2
In post menopause is E1(from the
peripheral conversion of
Androstenadione)
Clinical manifestation of
menopause
Cardiovascular system
changes
Leading cause of death - twice as many women die
of cardiovascular disease than of cancer
Incidence rates of coronary heart disease in both
men and women were similar 6-10 years after the
menopause
Serum cholesterol increases significantly at 1-2
yrs or more after the menopause - marked by an
increase in triglycerides, an increase in LDL,
decrease in HDL - and are less cardio protective
Menopause &Osteoporosis
25% of women have radiological evidence of
osteoporosis by 60; by 80Y 1 in 4 have fractured a
hip; after age 65 1 in 3 have a vertebral fracture
15% of women with hip fracture after age 80 will die
of complications within 6 months
Initial period of up to 4-5 years after the menopause
there is accelerated loss of bone at rate of 1-2% per
year; trabecular bone mainly
Bone loss is mainly in the trabecular type while cortical
type occur later .
Three most common fractures in postmenopausal
women - vertebrae, ultra distal radius and neck of
femur
Menopause &osteoporosis
Risk factors:
white or Asian
reduced weight for height
early spontaneous menopause or surgical menopause
family history of osteoporosis
low dietary calcium intake
low vitamin D intake
high caffeine intake
high alcohol intake
cigarette smoking
endocrine disorders - diabetes mellitus,
hyperthyroidism, Cushing disease
Hot Flushes
Cause of hot flushes: the mechanism is
not known, but data indicate that symptom
result from a defect in central
thermoregulatory function
A pulse of LH is released with the onset
of each hot flush, therefore a central
hypothalamic mechanism
Development of hot flushes more than1
year prior to the menopause is probably
not due to estrogen deficiency but to
other factors such as stress
MEDICAL MANAGEMENT
Management of menopause
Advise on a healthy life style
Psychological support
Hormone replacement therapy
Absolute contraindications
Existing breast cancer
Existing endometrial cancer
Venous thrombo-embolism
Acute liver disease
Routes of administration of
oestrogen
Oral
Transdermal
Implants
Local vaginal preparation
Oral therapy
Natural occurring oestrogens: includes
premarin and various oestradiol preparations. These
oestrogens are metabolised in the liver to the weaker
metabolite oestrone and then converted to oestradiol
in the peripheral circulation and in the target tissue.
Transdermal therapy
Patches (oestrogen only or combined
preparation) or oestrogen gels
Womens preference
Skin irritation may be a problem but new matrix
patches and the gels are usually well tolerated
Route of choice for women with risk factors for
venous thrombo-embolism, liver disease or
gastro-intestinal problems
Oestrogen implants
Now less widely used
Implants should be given no more than
every 6 month
HRT regimens
Women who have had a hysterectomy only
need to take oestrogen
Women with an intact uterus must take
progestogen for endometrial protection to
prevent endometrial cancer or hyperplasia
Regular surveillance of endometrium is
required for women (extreme intolerance of
progestogen) on unopposed oestrogen
HRT regimens
Sequential preparation: progestogen added for
12-14 days each month. Some women will not bleed on
sequential preparations and this is not a cause for
concern provided that the progestogen is taken correctly.
Nausea
breast pain
heavy or painful withdrawal period
premenstrual syndrome type of side
effects
weight gain
Nursing Management
Nurse can encourage women to view
menopause as a natural change
resulting in freedom from symptoms
related to menses .
No relationship existing between
menopause and mental health
problems .
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