Menopause

Menopause
Presentation lecture from: Uni. of Maryland

"Menopause is a wake-up call to a new phase of your life. A wake-up call most people cannot handle, but what's the choice? You sure can't go back to sleep. So get up and decide what you're doing today—and on into the years ahead." —modified after Marisa Weiss, M.D.

What Is Menopause?
* Menopause is defined as the cessation of ovarian function, or the cessation of menstrual cycles
* Menopause is a natural process, it is not a disease
* The mean age for menopause is 51 years
* One third of woman’s life occurs after menopause

Menopause

* Medical
* Surgical
* “Cold turkey"
* Persistent low (less tan 20 pg/ml) levels of estrogen
* Persistent elevated levels of
FSH (13–90 milli-international units per milliliter)
LH (15–50 mIU/mL).

Normal levels of estrogen before menopause peak at 150–300 picograms per milliliter each month (depending on where you are in your menstrual cycle)

Lack of negative feedback
What Is Perimenopause?

* Perimenopause is a transition rather than an event
* It is the period of time surrounding menopause when ovarian function is declining, but has not stopped
* Onset of perimenopause is usually 3-5 years before the periods stop
* Perimenopause and menopause may last 2-10 years

Other factors then hormones:

Empty nest, divorce, widowhood, the dependency of sick parents, the death of a parent or parents, or kids in trouble are all common experiences at this stage of life. Setting aside the hormonal changes that relate to menopause, it's common to feel stress, isolation, and depression.

Menopause/Aging

"Growing old is not for sissies”
Symptoms of Perimenopause

* Hot flashes
* Vaginal dryness
* Breast Tenderness
* Mood disturbances
* Sleep disturbances
* Urinary tract infections/incontinence
* Menstrual changes
* Sexual dysfunction

Other Physiologic Changes
* Slowing of metabolism
* Weight gain
* Changes in lipids
* Increase in heart disease
* Osteoporosis

Heart Disease

* Leading cause of death in women
* Higher risk after menopause probably due to changes in cholesterol levels when estrogen levels decline
* Elevated “bad” cholesterol (LDL)
* Lower “good” cholesterol (HDL)
* Elevation in triglycerides (fats)

Osteoporosis

* 1 out of 2 white women will have an osteoporotic fracture in their lifetime
* 24% of patients over age 50 will DIE in the year following an osteoporotic hip fracture
* Deaths due to osteoporosis far exceed the numbers of deaths due to breast cancer
* Other consequences- physical limitation, chronic pain, depression, poor quality of life

Menopause

Three factors affect how you age and how you experience menopause:

* Hormones — estrogen, progesterone, and others.
* Lifestyle — diet, exercise, weight, smoking, environment
* Genetic makeup — the genes that come from your parents, the blueprint of your constitution and perhaps your future health

Estrogen Replacement Therapy (ERT) or Hormone Replacement Therapy (HRT)
* Treats the symptoms of menopause (hot flashes, etc.)
* Prevention of heart disease (40-50% reduction in risk)
* Prevention and treatment of osteoporosis
* May help prevent dementia
* May prevent strokes
* Lower mortality rates in women who take estrogen

Side Effects of HRT

* Blood clots (especially in smokers)
* Gallbladder disease
* May increase risk of breast cancer
* Vaginal bleeding
* Breast tenderness

“Male” Hormones- Can They Help You?

* Androgens are produced in the ovaries and the adrenal glands
* Known to increase libido
* Protects bone mass
* Unfavorable effects on cholesterol
* Can cause virilization (unwanted hair growth)

Complementary Therapies

* Most lack scientific proof of efficacy
* Large placebo effect
* “Dietary supplements”- no regulation by FDA
* May be helpful for women who do not choose ERT/HRT or as adjunctive therapy

Lifestyle Approaches to Perimenopause

* Exercise- aerobic, weight-bearing, strengthening program
* High fiber, low fat, soy-rich diet
* Maintain regular sexual activity
* Relaxation and stress reduction activities
* Daily sunlight
* Decrease alcohol intake
* Stop Smoking

Summary

* Perimenopause is a process rather than an event
* Symptoms are common and most women will seek treatment
* ERT/HRT is the best treatment available for symptoms of menopause and to prevent long term consequences of estrogen deficiency
* Complementary therapies may be of some short term benefit for symptom control

Menopause: Hot Flushes
Menopause: Hot Flushes Misconception
Menopause: Hot Flushes Triggers
Hot Flush Therapies
Clinical data on current possible therapies for the treatment of hot flushes (HF)
Potential Vasomotor Pathways
Thermoregulatory
Center
Hypothalamus
serotonin
norepinephrine
neuropeptides
estrogen
progesterone
autonomic
nervous system
brain stem
vasodilatation or vasoconstriction
Heat loss (i.e., hot flush) or preservation
blood vessels in skin
Morphine-Dependent OVX Model
Direct Temperature Measurement
Thermistor
Amplifier
MacLab
Telemetric Temperature Measurement
Transmitter
THERMISTOR IMPLANTED
OVX-induced change in TST
Long-term monitoring
Dark phase (active)
Light phase (inactive)
OVX-Induced TST Change
Telemetry (Long-Term Monitoring)
Hot Flush - Gonadotropins
Finger temperature
Relative hormone levels during the menstrual cycle
Aging-related decline of hormonal systems
Hormone levels of women and men during aging

Andropause
Serum testosterone levels in young vs aged men
Gonadotropins and aging

Menopause.ppt