PHYSIOLOGY  OF  MENOPAUSE www.freelivedoctor.com
MENOPAUSE <ul><li>MENOPAUSE comes from the greek word ' menos'( month) and 'pausis'(cessation). </li></ul><ul><li>Diagnosi...
THE DECLINING OOCYTE POOL <ul><li>Accelerated follicular depletion begin at age 37-38, and menopause follows 13 years  </l...
COMPENSATED FAILURE <ul><li>Initially ovarian failure is compensated by rising Gn levels, about the age of 30yrs </li></ul...
DECOMPENSATED FAILURE <ul><li>Critical decline in oocyte pool leads to further rise in FSH.(10-20 FOLD) </li></ul><ul><li>...
OTHER HORMONAL CHANGES <ul><li>Both adrenal and ovarian androgen levels fall.the drop in androgen levels is profound in pr...
PREDICTION OF OVARIAN RESERVE <ul><li>FSH level>30 is diagnostic of menopause. </li></ul><ul><li>combination of FSH, INHIB...
PREMATURE OVARIAN FAILURE <ul><li>Defined as cessation of menstruation before the age of 40 years. </li></ul><ul><li>CAUSE...
CONSEQUENCES OF MENOPAUSE <ul><li>IMMEDIATE </li></ul><ul><li>INTERMEDIATE </li></ul><ul><li>LONG TERM </li></ul>www.freel...
IMMEDIATE <ul><li>HOT FLUSHES--- </li></ul><ul><li>Thought to arise due to loss of oestrogenic induced opioid activity in ...
<ul><li>INSOMNIA, ANXIETY, IRRITABILITY </li></ul><ul><li>POOR CONCENTRATION </li></ul><ul><li>MOOD DISTURBANCES </li></ul...
INTERMEDIATE CONSEQUENCES <ul><li>Oestrogen deficiency leads to rapid loss of collagen </li></ul><ul><li>dyspareunia and v...
Long term health problems <ul><li>Osteoporosis  </li></ul><ul><li>Disorder of bone matrix resulting in reduction in bone s...
Cardiovascular <ul><li>Protective effect of oestrogen— </li></ul><ul><li>increase in HDL </li></ul><ul><li>decrease in LDL...
<ul><li>Risk factors include high BMI and a decrease in oestradiol levels. </li></ul><ul><li>Women with day3FSH > 7 IU/ml ...
C N S <ul><li>Oestrogen has a direct effect on the vasculature of the CNS and promotes neuronal growth and neurotransmissi...
Diagnosis <ul><li>Characteristic history of hot flushes and night sweats with prolonged periods of amenorrhoea. Measuremen...
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Menopause

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Menopause

  1. 1. PHYSIOLOGY OF MENOPAUSE www.freelivedoctor.com
  2. 2. MENOPAUSE <ul><li>MENOPAUSE comes from the greek word ' menos'( month) and 'pausis'(cessation). </li></ul><ul><li>Diagnosis is made retrospectively after a minimum of one year amenorrhoea. </li></ul><ul><li>PERIMENOPAUSAL TRANSITION-- </li></ul><ul><li>The years prior to menopause that encompass the change from normal ovulatory cycles to cessation of menses. </li></ul>www.freelivedoctor.com
  3. 3. THE DECLINING OOCYTE POOL <ul><li>Accelerated follicular depletion begin at age 37-38, and menopause follows 13 years </li></ul><ul><li>later. </li></ul><ul><li>menopause occurs when the number of follicles falls below a critical threshold, about 1000 ,regardless of age. </li></ul>www.freelivedoctor.com
  4. 4. COMPENSATED FAILURE <ul><li>Initially ovarian failure is compensated by rising Gn levels, about the age of 30yrs </li></ul><ul><li>inhibin production from granulosa cells fall leading to a reduced INHIBIN : FSH ratio. </li></ul>www.freelivedoctor.com
  5. 5. DECOMPENSATED FAILURE <ul><li>Critical decline in oocyte pool leads to further rise in FSH.(10-20 FOLD) </li></ul><ul><li>LH rises only 3-fold due to its shorter half life. </li></ul><ul><li>OESTROGEN levels drop due to reduction in follicle number and granulosa cell ageing. </li></ul><ul><li>Permanent cessation of progesterone production. </li></ul>www.freelivedoctor.com
  6. 6. OTHER HORMONAL CHANGES <ul><li>Both adrenal and ovarian androgen levels fall.the drop in androgen levels is profound in premature ovarian failure. </li></ul><ul><li>OESTROGEN therapy increase SHBG LEVELS ---further fall in free androgen levels. </li></ul><ul><li>Main postmenopausal oestrogen is oestrone-produced mainly by adipose tissue and </li></ul><ul><li>postmenopausal ovary by aromatization of adrenal androstenedione. </li></ul><ul><li>insulin resistance and rise in central adiposity. </li></ul>www.freelivedoctor.com
  7. 7. PREDICTION OF OVARIAN RESERVE <ul><li>FSH level>30 is diagnostic of menopause. </li></ul><ul><li>combination of FSH, INHIBIN WITH ANTI-MULLERIAN HORMONE. </li></ul><ul><li>Measurement of ovarian volume. </li></ul>www.freelivedoctor.com
  8. 8. PREMATURE OVARIAN FAILURE <ul><li>Defined as cessation of menstruation before the age of 40 years. </li></ul><ul><li>CAUSES : </li></ul><ul><li>spontaneous or idiopathic </li></ul><ul><li>turner syndrome </li></ul><ul><li>fragile X syndrome </li></ul><ul><li>FSH receptor polymorphism </li></ul><ul><li>INCIDENCE IS RISING. </li></ul>www.freelivedoctor.com
  9. 9. CONSEQUENCES OF MENOPAUSE <ul><li>IMMEDIATE </li></ul><ul><li>INTERMEDIATE </li></ul><ul><li>LONG TERM </li></ul>www.freelivedoctor.com
  10. 10. IMMEDIATE <ul><li>HOT FLUSHES--- </li></ul><ul><li>Thought to arise due to loss of oestrogenic induced opioid activity in the hypothalamus. </li></ul><ul><li>NA and serotonin mediate this activity. </li></ul><ul><li>Obese women are protected due to large amounts of oestrone and low SHBG. </li></ul>www.freelivedoctor.com
  11. 11. <ul><li>INSOMNIA, ANXIETY, IRRITABILITY </li></ul><ul><li>POOR CONCENTRATION </li></ul><ul><li>MOOD DISTURBANCES </li></ul><ul><li>REDUCTION IN SEXUALITY AND LIBIDO </li></ul><ul><li>MEMORY LOSS </li></ul>www.freelivedoctor.com
  12. 12. INTERMEDIATE CONSEQUENCES <ul><li>Oestrogen deficiency leads to rapid loss of collagen </li></ul><ul><li>dyspareunia and vaginal bleeding </li></ul><ul><li>urethral syndrome(dysuria, urgency and frequency) </li></ul><ul><li>increased bruising </li></ul><ul><li>generalized aches and pains </li></ul>www.freelivedoctor.com
  13. 13. Long term health problems <ul><li>Osteoporosis </li></ul><ul><li>Disorder of bone matrix resulting in reduction in bone strength to the extent that there is increased risk of fractures. </li></ul><ul><li>Women lose 50% of their skeleton by the age of 70 years, but men only lose 25% by the age of 90 years. </li></ul><ul><li>Predisposing factors- </li></ul><ul><li>genetic predisposition, use of corticosteroids, pre-menopausal amenorrhea, smoking, premature ovarian failure </li></ul>www.freelivedoctor.com
  14. 14. Cardiovascular <ul><li>Protective effect of oestrogen— </li></ul><ul><li>increase in HDL </li></ul><ul><li>decrease in LDL </li></ul><ul><li>NO mediated vasodilatation </li></ul><ul><li>antioxidant effect </li></ul><ul><li>direct effect on aorta decreasing atheroma </li></ul>www.freelivedoctor.com
  15. 15. <ul><li>Risk factors include high BMI and a decrease in oestradiol levels. </li></ul><ul><li>Women with day3FSH > 7 IU/ml compared to those with day3 FSH < 7 IU/ ml were found to have higher lipid levels. </li></ul>www.freelivedoctor.com
  16. 16. C N S <ul><li>Oestrogen has a direct effect on the vasculature of the CNS and promotes neuronal growth and neurotransmission. Also improves cerebral perfusion and cognition in women. </li></ul><ul><li>Causes alzheimers disease, dementia. (intervenes at the level of amyloid precursor protein). </li></ul>www.freelivedoctor.com
  17. 17. Diagnosis <ul><li>Characteristic history of hot flushes and night sweats with prolonged periods of amenorrhoea. Measurement of plasma hormone level is not necessary. </li></ul><ul><li>However in a young patient or in a woman after hysterectomy, where the diagnosis is more difficult, measurement of FSH is helpful. </li></ul><ul><li>(> 15 iu/ml). </li></ul>www.freelivedoctor.com

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