menopause
refers to a point in time that follows 1 year after the cessation of menstruation
postmenopause
years following menopause
average age of menopause in the US
51.5 years
average lifespan of US women
81 years
perimenopause or climacteric
time period in the late reproductive years, usually late 40s to early 50s immediately before menopause
- menopausal transition
onset ~47 years old and spans over 4-7 years
menopause transition begins with
menstruation irregularity
ovarian mass and fertility
decline sharply after age 35 and even more precipitously during menopausal transition
depletion of primary follicles
occurs steadily until menopause
cigarette smokers experience menopause
~ years earlier
anovulatory cycles produce
a hyper-estrogenic & progesterenic state that may account for the increased incidence of endometrial hyperplasia or carcinoma & uterine polyps among women of perimenopausal age
with transition into menopause
estradiol falls remarkedly, whereas FSH (more) & LH levels increase
Due to loss of inhibin & estrogen feedback regulation, what levels are relatively preserved?
estrone
symptoms of perimenopausal transition
- changes in mentrual patterns
- vasomotor symptoms
- psychological & mental changes
- sexual dysfunction
- somatic symptoms
- other issues
changes in menstrual patterns
shorter cycles (2-7 days) or longer cycles, irregular bleeding (heavy, light, spotting)
vasomotor symptoms
hot flashes, night sweats, sleep disturbances
psychological & mental changes
worsening PMS, depression, irritability, mood swings, loss of concentration, poor memory
sexual dysfunction
vaginal dryness, decreased libido, painful intercourse
somatic symptoms
HA, dizziness, palpitations, breast pain & enlargement, joint aches and back pain
other issues
dry, itch skin & thinning of skin, weight gain, muscle weakness, urinary incontinence, CVD, reduction in bone density
most common complaint during menopausal transition
hot flashes
what can suppress hot-flashes
estrogen therapy
how long does a hot flash usually last?
1-5 minutes
BP, HR and metabolic rate all rise during
a hot flash
hot flashes may also be accompanied by
palpitations, anxiety, irritability and panic
the medial preopitic area of the hypothalamus contains the
thermoregulatory nucleus responsible for regulating perspiration and vasodilation, which is the primary mechanism of heat loss in humans
what plays a vital role in the development of hot flashes?
- estrogens.
- estrogen levels modulate central thermoregulation
- estrogens are known to modulate adrenergic receptors
NE & HT are critical NTs involved in
- lowering the thermoregulatory setpoint and triggering heat loss mechanisms associated with hot flashes
- decreased Estrogen is though to lower HT release & lead to altered HT neurotransmission
- increase NE signalling-> heat loss
normal rate of bone mass decline
0.4% each year
bone mass decline rate during menopause
2-5% per year for the first 5 tp 10 years then slows to 1% per year
loss of estrogen leads to
enhanced loss of bone mass & predisposes pts to fractures.
why women have a lower risk of CVD than men before menopause
greater HDL levels which is an effect of estrogen
hormone replacement therapy (HRT)
- only 30% of eligible women receive HRT
women’s health initiative (WHI)
stopped early. no effect on CHD or breast cancer - increased risk of stroke, ovarian cancer in estrogen only - increased risk of blood clots in E/P - incr. risk of breast cancer
Estrogen effect on cholesterol
decrease LDL and increase HDL
- HRT is not recommended solely for the prevention of high cholesterol or heart disease
increased risk of blood clots in women taking
estrogen