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Menopause

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    Menopause Menopause Presentation Transcript

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