30 Questions
What is the primary definition of menopause?
The permanent cessation of menstruation due to ovarian follicular development failure.
What is the primary hormonal change after menopause?
An increase in FSH and LH.
What is the most common symptom of vasomotor instability?
Hot flashes.
Which group of women is less troubled by hot flashes?
Obese women.
When do hot flashes typically begin in relation to menopause?
Within 3 months of menopause.
How do hot flashes change over time?
They decrease in frequency and intensity.
What is the effect of estrogen on cardiovascular health?
It is cardio-protective and increases HDL.
What happens to the risk of cardiovascular disease after menopause?
It increases.
What is a common psychological change associated with menopause?
All of the above.
What is a common genitourinary change associated with menopause?
All of the above.
What is the primary function of osteoclasts in bone metabolism?
Breaking down bone tissue
What is the normal rate of bone loss per year after peak bone density in the 20s?
0.5% per year
What is the approximate rate of bone loss per year during the first 5 years after menopause?
5% per year
What is the hormone that inhibits osteoclastic bone resorption?
Calcitonin
Which of the following is a risk factor for osteoporosis that cannot be changed?
Gender
What is the approximate percentage of women who will suffer a vertebral fracture after the age of 65?
One third
What is the most common site of fracture in osteoporosis?
All of the above
What is the name of the hormone that stimulates osteoclastic bone resorption?
Parathyroid hormone (PTH)
Which of the following is a modifiable risk factor for osteoporosis?
Smoking
What is the approximate age by which one half of women will suffer a hip fracture?
90 years
What happens to the vaginal walls after the loss of estrogen at menopause?
They become pale and thinner due to diminished vascularity
What is the function of lactobacilli in pre-menopausal women?
To create a protective mechanism by metabolizing glycogen to produce acidic pH
What is the effect of loss of estrogen on vaginal epithelial cells?
They contain less glycogen
What is a symptom of genitourinary atrophy?
Dyspareunia
What is the effect of estrogen replacement therapy on skin collagen?
It prevents and reverses skin collagen loss
What is the primary cause of osteoporosis?
Imbalance between osteoclastic and osteoblastic activity
What is the effect of menopause on vaginal rugae?
They disappear
What is a psychological change associated with menopause?
Irritability and anxiety
What is the percentage of skin collagen lost during the first five years of menopause?
30%
What is a symptom of osteoporosis?
Increased bone fragility
Study Notes
Menopause
- Menopause is the permanent cessation of menstruation due to failure of ovarian follicular development in the presence of adequate gonadotropins.
- Diagnosis of menopause is established when menstruation stops for 12 months in absence of an organic or a pathological cause.
Climacteric
- Climacteric is the physiological period in a woman's life during which ovarian function regresses.
- Menopause is only one aspect of the climacteric, during which time women undergo endocrine, somatic, and psychological changes that span several years.
Stages of Menopause
- Pre-menopause
- Climacteric
- Post-menopause
Hormonal Changes After Menopause
- FSH and LH are elevated >25 IU/L
- Estrogen decreases
- Decrease progesterone and inhibin
- Testosterone is relatively increased
Clinical Changes
- Menstrual changes
- Vasomotor instability
- Osteoporosis
- Cardiovascular changes
- Genitourinary atrophy
- Psychological changes
- Skin collagen changes
Menstrual Changes
- Most women note a gradual tapering in both amount and duration of flow
- A minority of women have more frequent and heavier bleeding
- Abrupt cessation of menses is fairly rare
Vasomotor Instability (Hot Flashes)
- Most common and troublesome symptoms for women at the climacteric
- Obese women are less troubled by hot flashes than thin women
- 75% of women experience hot flashes within 3 months of menopause
- Hot flashes lessen in frequency and intensity with advancing age
Cardiovascular Changes
- Estrogen is a cardio-protective
- Estrogen increases HDL and decreases LDL
- Risk of cardiovascular disease increases after menopause
Genitourinary Atrophy
- Vaginal walls become pale due to diminished vascularity and thin
- Vaginal epithelial cells contain less glycogen, leading to loss of protective mechanism
- Vagina loses its rugae and becomes shorter and inelastic
Symptoms of Genitourinary Atrophy
- Dyspareunia
- Vaginitis
- Vaginal dryness
- Dysuria
- Urgency and frequency of urination
- Supra-pubic pain
Psychological Changes
- Irritability and anxiety
- Depression
- Lack of concentration
- Change of libido
- Alzheimer's disease
Skin Collagen Changes
- Up to 30% of skin collagen can be lost during the first five years of menopause
- Changes can be prevented and reversed with Estrogen Replacement Therapy (ERT)
Osteoporosis
- Reduction of bone mass density with micro-architectural alteration and increase bone fragility
- Imbalance between osteoclastic and osteoblastic activity (defective remodeling)
Risk Factors for Osteoporosis
- Unchangeable factors:
- Gender
- Heredity
- Age
- Fracture history
- Medical conditions (e.g. hyperthyroidism, parathyroidism)
- Medications for chronic diseases (e.g. steroids)
- Changeable factors:
- Calcium consumption
- Vitamin D intake
- Quit smoking or vaping
- Alcohol consumption
- Physical activity
- Posture
- Low body weight (BMI < 20)
- Some medications
Complications of Osteoporosis
- Fractures
- Most common sites of fracture are the vertebrae, femur neck, and distal radius
- One-third of women will suffer vertebral fracture after 65 years of age and hip fracture by age 90
Learn about the definitions of menopause and climacteric, including the diagnosis and symptoms of menopause. Understand the physiological period of ovarian function regression in a woman's life.
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