Women’s Health Study Guide – Menopause, Perimenopause &
Osteoporosis (Case 3)
1. menstrual cycle
changes
3. Menopausal transition
4. Perimenopuase
2. Menopause defi-
nition
, Women’s Health Study Guide – Menopause, Perimenopause &
Osteoporosis (Case 3)
-abnormal ueterine bleeding is -menses are more frequent (shorter cycles 2-7 days)
cased by orarian dysfunction -increased blood flow
-heavier blleding than normal -premenstrual spotting
-prolonged bleeding
-menses occuring more than Late menopausal transition:
every 3 weeks -menses skipped > cycles lengthened
-spotting between menses -menses are often more than 2 months apart
-bleeding after sex
-amenorrhea time period from menstrual cycle irregularity to final menstrual period
MANAGEMENT:
-most irregular bleeding
during perimenopause is
normal
-if significant change in
bleeding, patient should be
referred for further evaluation
point in time
cessation of menses for at-
least 12 consecutive months
(retroactive determina- tion)
-natural menopause occurs
around 52 years of age (before
age 40, considered premature
menopause and after 55 eyars
considered late menopause)
early to middle menopausal
transition:
, Women’s Health Study Guide – Menopause, Perimenopause &
Osteoporosis (Case 3)
climacteric
time leading to menopause, typically cahracterized by missed menses or W/O
symptoms of hypoestrogenism
-perimenopause has an average duration of 4 years with a range of 2-8 years
5. postmenopause all years following final menstrual period
6. premature ovari- cessation of menses prior to age 40
an failure
7. Menopause At the time of menopause, the ovary has no follicles left that respond to the
Physiology stimulation of follicle-stimulating hormone (FSH).
The lack of follicular stimulation and development signals the end of the regular
menstrual cycle and the monthly fluctuations of both estradiol and progesterone
concentrations.
Without follicular development and the designation of a graafian (dominant) fol-
licle, estradiol concentrations remain low and ovulation does not occur; therefore,
progesterone concentrations remain low as well.
As a result, endometrial proliferation occurs rarely and there are no secretory
changes. The pituitary gland increases the production and release of both FSH
and luteinizing hormone (LH) in an attempt to entice the ovary to initiate follicular
development.
The ovary cannot respond; therefore, FSH and LH concentrations remain elevated
while estradiol and progesterone concentrations remain low.
The postmenopausal female continues to produce estrogen in the adipose tissue
as a result of the conversion of androstenedione (from the adrenal gland) to
estrone.[2] The amount of estrone produced depends on the amount of adipose
tissue present. Estrone has a weaker ettect on the endometrium than estradiol;
therefore, proliferation of endometrial tissue is rare, except in women who are
obese.
, Women’s Health Study Guide – Menopause, Perimenopause &
Osteoporosis (Case 3)
During perimenopause, cessation of menses, along with the increase in FSH and
LH and decrease in estradiol and progesterone, occurs gradually over several
months to years.[2] The ovary becomes slow to respond to FSH and LH. Therefore,
it can take longer for follicular development and endometrial proliferation to occur;
however, unlike in menopause, the follicles in the ovary are still able to respond
and ovulation does still occur.
8. clinical pre- -absense of menses for 12 consecutive months
sentation of -blood tests to measure FSH and estradiol levels
Menopause -signs and sX of hypoestrogenism>> unknown if these Sxs are a result of decreased
Signs + Symp- hormone concentrations or secondary to vasomotor and urogenital symptoms.
toms
perimenopausal:
-decreased libido
-dyspareunia
-reduced vaginal lubrication
-valvovaginal itchig and irritation
Menopausal:
-sexual diflculties
-urinary tract infections
-incontinence
MOST PREVELANT
-hot flashes
-night sweats
-disrupted sleep (associated factors: Vasomotor symptoms, hormone dynamics,
primary sleep disorders, mental health symptoms, medical problems, lifestyle
factors, psychosocial factors)
-vaginal dryness
-loss intrest in sex
Osteoporosis (Case 3)
1. menstrual cycle
changes
3. Menopausal transition
4. Perimenopuase
2. Menopause defi-
nition
, Women’s Health Study Guide – Menopause, Perimenopause &
Osteoporosis (Case 3)
-abnormal ueterine bleeding is -menses are more frequent (shorter cycles 2-7 days)
cased by orarian dysfunction -increased blood flow
-heavier blleding than normal -premenstrual spotting
-prolonged bleeding
-menses occuring more than Late menopausal transition:
every 3 weeks -menses skipped > cycles lengthened
-spotting between menses -menses are often more than 2 months apart
-bleeding after sex
-amenorrhea time period from menstrual cycle irregularity to final menstrual period
MANAGEMENT:
-most irregular bleeding
during perimenopause is
normal
-if significant change in
bleeding, patient should be
referred for further evaluation
point in time
cessation of menses for at-
least 12 consecutive months
(retroactive determina- tion)
-natural menopause occurs
around 52 years of age (before
age 40, considered premature
menopause and after 55 eyars
considered late menopause)
early to middle menopausal
transition:
, Women’s Health Study Guide – Menopause, Perimenopause &
Osteoporosis (Case 3)
climacteric
time leading to menopause, typically cahracterized by missed menses or W/O
symptoms of hypoestrogenism
-perimenopause has an average duration of 4 years with a range of 2-8 years
5. postmenopause all years following final menstrual period
6. premature ovari- cessation of menses prior to age 40
an failure
7. Menopause At the time of menopause, the ovary has no follicles left that respond to the
Physiology stimulation of follicle-stimulating hormone (FSH).
The lack of follicular stimulation and development signals the end of the regular
menstrual cycle and the monthly fluctuations of both estradiol and progesterone
concentrations.
Without follicular development and the designation of a graafian (dominant) fol-
licle, estradiol concentrations remain low and ovulation does not occur; therefore,
progesterone concentrations remain low as well.
As a result, endometrial proliferation occurs rarely and there are no secretory
changes. The pituitary gland increases the production and release of both FSH
and luteinizing hormone (LH) in an attempt to entice the ovary to initiate follicular
development.
The ovary cannot respond; therefore, FSH and LH concentrations remain elevated
while estradiol and progesterone concentrations remain low.
The postmenopausal female continues to produce estrogen in the adipose tissue
as a result of the conversion of androstenedione (from the adrenal gland) to
estrone.[2] The amount of estrone produced depends on the amount of adipose
tissue present. Estrone has a weaker ettect on the endometrium than estradiol;
therefore, proliferation of endometrial tissue is rare, except in women who are
obese.
, Women’s Health Study Guide – Menopause, Perimenopause &
Osteoporosis (Case 3)
During perimenopause, cessation of menses, along with the increase in FSH and
LH and decrease in estradiol and progesterone, occurs gradually over several
months to years.[2] The ovary becomes slow to respond to FSH and LH. Therefore,
it can take longer for follicular development and endometrial proliferation to occur;
however, unlike in menopause, the follicles in the ovary are still able to respond
and ovulation does still occur.
8. clinical pre- -absense of menses for 12 consecutive months
sentation of -blood tests to measure FSH and estradiol levels
Menopause -signs and sX of hypoestrogenism>> unknown if these Sxs are a result of decreased
Signs + Symp- hormone concentrations or secondary to vasomotor and urogenital symptoms.
toms
perimenopausal:
-decreased libido
-dyspareunia
-reduced vaginal lubrication
-valvovaginal itchig and irritation
Menopausal:
-sexual diflculties
-urinary tract infections
-incontinence
MOST PREVELANT
-hot flashes
-night sweats
-disrupted sleep (associated factors: Vasomotor symptoms, hormone dynamics,
primary sleep disorders, mental health symptoms, medical problems, lifestyle
factors, psychosocial factors)
-vaginal dryness
-loss intrest in sex
