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Gyn CM Menopause

Gynecology CM Menopause

QuestionAnswer
The Seven Dwarves of Menopause Itchy, Bitchy, Sweaty, Sleepy, Bloated, Forgetful, and Psycho
Menopause over time The age of menopause hasn't changed since ancient times
Late menopause refers to menopause after age 55
Natural Menopause The permanent cessation of menstruation resulting from the loss of ovarian follicular activity. Occurs with the final period and is konwn only in retrospect after at least a year. No biological markers
Mean age of menopause 51.3 years (range 40-59 years). Varies by racial and ethnic group. Perimenopause or menopausal transition usually lasts 4 years (!) (range:2-9years). 10% of women stop abruptly. Women may be potentially fertile during this time
Female Axis Hypothalamus releases FSH-RH and LH-RH (negative feedback), Anterior Pit releases FSH and LH (negative feedback), Ovaries release Estrogen and Progestin which act on the uterus and cause menses
Why would a woman in menopause have high FSH and LH levels? Hypothalamus and Anterior pituitary will pump out hormones b/c the ovaries are not releasing estrogen and progestin due to menopause. So, Hypothalamus and Anterior Pit will respond until they are exhausted and completely stop (FSH>LH).
LH surge is at what point in the menstruation cycle? Ovulation during the proliferative phase.
When is the estradiol peak in the menstruation cycle? Ovulation during the proliferative phase
When is body temperature the highest? at Ovulation during the proliferative phase. It increases .5 degrees celsius.
When are estradiol and progesterone the lowest? a few days prior to menses and menses (going upwards)
Ovarian Fxn and Hormones oocytes disappear from ovary and/or remaining oocytes do not respond to gonadotropins, fewer ovarian follicles, ovaries produce less hormones, increase in gonadotropins (LH, FSH), decreased sensitivity in target organs
Hormonal changes around menopause fluctuations common throughout perimenopause, serum hormone levels do not correspond with sx, DECREASED OVARIAN ESTROGEN, ANDROGEN AND PROGESTERONE
Changes in Estrogen (at least 30% decrease) Greatest decrease in estradiol (predominant premenopausal ovarian estrogen), increase in esterone (predominant postmenopausal ovarian estrogen), different proportions of estrogen, higher levels if obese
How does ovarian androgen androstenedione change during menopause? decreases 50%. Weak androgen converted peripherally in adipose tissue to esterone. After menopause, androgen is mainly adrenal source. Postmenopausal ovary secretes relatively more androgen than estrogen. Testosterone decreased by 1/3, lower progesterone
How do prolactin levels change? Prolactin levels decrease after cessation of menses
Factors that cause menopause to occur earlier familial factors, current smoking (2 years earlier), alcohol abuse, nulliparity, medically treated depression, shorter menses during adolescence, DM I, Toxic chemical exposure, Tx of childhood CA with pelvic radiation and alkylating agents
Factors that cause menopause to occur later multiparity, increased BMI (due to increased estrogen levels), hx of OCP use
Menopausal sx cultural variation, worsened if fear of aging and higher SES
Neuroendocrine Sx Hot flushes and hot flashes
Skin, Mucous membrane Sx Dry hair, hair loss, facial hirsutism, dry mouth
Skeleton Sx Osteoporosis, fractures, Back pain
Vocal Cord Sx lower voice
Breast Sx reduced size, softer, loss of ligamentous support.
Heart Sx Coronary Artery Disease
Vaginal Sx Dyspareunia, Vaginitis
Uterus/pelvic floor sx uterovaginal prolapse
Bladder/urethra sx Cytoureteritis, Ectropion, frequency, Urgency, Stress incontinence
Vulva Sx atrophy, dystrophy, pruritis vulvae
Created by: ltm12
 

 



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