Menopause and Osteoporosis (PDF)

Dr Ahmed Reda  Definitions:  Menopause: it is the permanent cessation of Menopause: 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...

Dr Ahmed Reda  Definitions:  Menopause: it is the permanent cessation of Menopause: 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.  Definitions:  Climacteric: is the physiological period in woman’s Climacteric: 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 Menopause Pre- Post-menopause menopause Climacteric 4  Hormonal changes after the menopause  FSH, LH are elevated >25 IU/L  Estrogen decreases  Decrease progesterone & inhibin  Testosterone is relatively increased  Clinical changes  Menstrual changes.  Vasomotor instability.  Osteoporosis.  Cardiovascular changes.  Genitourinary atrophy.  Psychological changes.  Skin collagen.  I- 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.  2- Vasomotor instability (Hot Flashes)  The most common and troublesome symptoms for women at the climacteric  Obese women usually 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 unlike the other sequelae of menopause that progress with time  4- Cardiovascular changes  Estrogen is a cardio-protective.  It increases the HDL and deceases the LDL.  Risk of cardiovascular disease increase after menopause.  5- Genito Genito--Urinary Atrophy  After the loss of estrogen at menopause, the vaginal walls become pale because of diminished vascularity and thin (typically 3 or 4 cells thick).  Vaginal epithelial cells contain less glycogen, which, before menopause had been metabolized by lactobacilli to create acidic PH.  Loss of this protective mechanism leaves the thin, friable tissue vulnerable to infection and ulceration.  The vagina also loses its rugae and becomes shorter and inelastic. Symptoms secondary to genitourinary atrophy  Dyspareunia.  Vaginitis.  Vaginal dryness.  Dysuria.  Urgency, frequency of urination.  Supra-pubic pain.  6- Psychological changes  Irritability, anxiety.  Depression.  Lack of concentration.  Change of libido.  Alzheimer’s disease.  7- Skin collagen  During the first five years of the menopause, up to 30% of skin collagen can be lost.  The changes can be prevented and in some cases reversed with Estrogen Replacement Therapy (ERT).