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*menarche (puberty)
*menstrual cycle
*menopause and HRT
*climacterium praecox,
climacterium tardum,
iatrogenic menopause.
...
Hormones:
1) Estrogens - estradiol (12-80x more
potent)
- estrone
- estriol
2) Progestin - progesterone
-17-hydroxyprogest...
menarche (puberty)
• sequence of biochemical and
physiologic events (adrenarche
and gonadarche)

result in the growth spur...
• Adrenarche:  ↑ secretion of
androgens by the adrenal gland,
(age 5 – 20)
• Gonadarche:  the initiation of
production of ...
Age at menarche, (n = 397)
• 
Natural menopause
*end of reproductive life
*the permanent cessation of
menstruation
*loss of ovarian follicular activity
...
Dx menopause :
1) No menses > 12 mths
2) 17β-estradiol levels < 74 pmol/L
3) FSH levels > 30 IU/L
(Nik Nasri Ismail, ‘Meno...
Age and menopausal status :
Perimenopause
• immediately prior to the
menopause and the first year
after menopause.
Climacteric
-incorporates the perimenopause
(a longer variable period before
and after the perimenopause).
-“climacteric s...
senium
• Phase of life started from 65 –
70 years upwards
• FSH and LH levels drop again
(age-related involution of the
pi...
Statistics
• Mean age for menopause is 50.7
years (Seng CK, 1986).
• Women’s life expectancy : 68 yrs in
1985 to 74 yrs in...
Endocrinology of
menopause
Less negative feedback,
↑FSH, ↑LH
Hypothalamo-pituitary tact
↓ovarian follicular
estrogen
↓ cir...
Endocrinology of
menopause
• adrenal androgen (by ovarian
stromal)
• in response to elevated LH
levels
• Androgen : estrog...
Pituitary gonadotropins
FSH - follicle stimulating hormone
LH - luteinizing hormone
PRL - prolactin
FSH - follicle stimulating
hormone
In Females,
• responsible for the early
growth of ovarian follicles
In Males,
• helps m...
LH - luteinizing hormone
In Females,
• final maturation of the ovarian
follicles and their estrogen
secretion, for ovulati...
Action of Estrogen :
Common Clinical
Symptoms
• Vasomotor flushes (hot flushes)
- 95% ☞ within three months,
(85% : symptom > one year)
- sudde...
• Osteoporosis
-Estrogens,
☺inhibit osteoclast function
☺increase intestinal Ca2+absorption
-Peak bone mass age 30,
with 0...
• Urogenital atrophy
- atrophic urethritis and cystitis
- Vulva and vagina : ↓ mucuos
production, thin epithelium
• Cardiovascular disease
- ↑↑ CHD in postmenopausal ≈ men at
the age 70 (B.Ettinger et al.,1996 and
S.A Samaan et al.,1995...
Circulation index (hot flushes, sweats,
palpitations, dizziness) and
Nervosity index (irritability, headache,
depression, ...
Increased Risk factors for
Menopause:

• Environmental influences may
alter the ovarian aging process.
• Smoking and high ...
Selection of patients for HRT:
• 1. Pap smear for those with uterus
• 2. Fasting lipid profile
• 3. Mammography
• 4. Fasti...
HRT or NO HRT???
Controversial :
• Important studies :
1) The Heart and
Estrogen/Progestin
Replacement Study (HERS)
2) Women’s Health initi...
Climacteric
Climacteric
Climacteric
Climacteric
Climacteric
Climacteric
Climacteric
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Climacteric

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Transcript of "Climacteric"

  1. 1. *menarche (puberty) *menstrual cycle *menopause and HRT *climacterium praecox, climacterium tardum, iatrogenic menopause. *senium
  2. 2. Hormones: 1) Estrogens - estradiol (12-80x more potent) - estrone - estriol 2) Progestin - progesterone -17-hydroxyprogesterone 3) Androgens - testosterone
  3. 3. menarche (puberty) • sequence of biochemical and physiologic events (adrenarche and gonadarche) result in the growth spurt of adolescence, development of secondary sex characteristics, and reproductive capacity
  4. 4. • Adrenarche:  ↑ secretion of androgens by the adrenal gland, (age 5 – 20) • Gonadarche:  the initiation of production of significant amount of sex steroids
  5. 5. Age at menarche, (n = 397) • 
  6. 6. Natural menopause *end of reproductive life *the permanent cessation of menstruation *loss of ovarian follicular activity *no pathological cause
  7. 7. Dx menopause : 1) No menses > 12 mths 2) 17β-estradiol levels < 74 pmol/L 3) FSH levels > 30 IU/L (Nik Nasri Ismail, ‘Menopause and HRT in Malaysia’ in First Consensus Meeting on Menopause in the East Asian Region)
  8. 8. Age and menopausal status :
  9. 9. Perimenopause • immediately prior to the menopause and the first year after menopause.
  10. 10. Climacteric -incorporates the perimenopause (a longer variable period before and after the perimenopause). -“climacteric syndrome.”
  11. 11. senium • Phase of life started from 65 – 70 years upwards • FSH and LH levels drop again (age-related involution of the pituitary gland).
  12. 12. Statistics • Mean age for menopause is 50.7 years (Seng CK, 1986). • Women’s life expectancy : 68 yrs in 1985 to 74 yrs in 1993 (Arshat H et al., 1989). ☞ 1/3 life, in a hypoestrogenic state.
  13. 13. Endocrinology of menopause Less negative feedback, ↑FSH, ↑LH Hypothalamo-pituitary tact ↓ovarian follicular estrogen ↓ circulating estrogen (estrone) to target tissues
  14. 14. Endocrinology of menopause • adrenal androgen (by ovarian stromal) • in response to elevated LH levels • Androgen : estrogen ratio (facial hair, male pattern baldness)
  15. 15. Pituitary gonadotropins FSH - follicle stimulating hormone LH - luteinizing hormone PRL - prolactin
  16. 16. FSH - follicle stimulating hormone In Females, • responsible for the early growth of ovarian follicles In Males, • helps mantain the spermatogenic epithelium by stimulating Sertoli cells
  17. 17. LH - luteinizing hormone In Females, • final maturation of the ovarian follicles and their estrogen secretion, for ovulation, the initial formation of the corpus luteum and secretion of progesterone In Males, • stimulation of testosterone production from Leydig cells of testis
  18. 18. Action of Estrogen :
  19. 19. Common Clinical Symptoms • Vasomotor flushes (hot flushes) - 95% ☞ within three months, (85% : symptom > one year) - sudden sensation of intense warmth accompanied by a visible ascending flush of the thorax, neck, and face, followed by profuse sweating.
  20. 20. • Osteoporosis -Estrogens, ☺inhibit osteoclast function ☺increase intestinal Ca2+absorption -Peak bone mass age 30, with 0.2% loss/year after age 40, becomes 4%/year at menopause -bone fragility and fracture
  21. 21. • Urogenital atrophy - atrophic urethritis and cystitis - Vulva and vagina : ↓ mucuos production, thin epithelium
  22. 22. • Cardiovascular disease - ↑↑ CHD in postmenopausal ≈ men at the age 70 (B.Ettinger et al.,1996 and S.A Samaan et al.,1995) by influencing: 1) lipoprotein level 2) direct action on arterial wall - Abnormal coagulation system
  23. 23. Circulation index (hot flushes, sweats, palpitations, dizziness) and Nervosity index (irritability, headache, depression, insomnia) :
  24. 24. Increased Risk factors for Menopause: • Environmental influences may alter the ovarian aging process. • Smoking and high coffee intake advances the age of menopause by about 2 years (Kaufmann DW et al,1980). • Familial and genetic factors • Ovarian surgery, adhesions, and pelvic endometriosis
  25. 25. Selection of patients for HRT: • 1. Pap smear for those with uterus • 2. Fasting lipid profile • 3. Mammography • 4. Fasting blood sugar • 5. Others if indicated — endometrial biopsy, FSH, LH, ultrasound
  26. 26. HRT or NO HRT???
  27. 27. Controversial : • Important studies : 1) The Heart and Estrogen/Progestin Replacement Study (HERS) 2) Women’s Health initiative study (WHI)(JAMA, 2002)

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