SN3
SHORT NOTE
5M
★ High-yield
Define menopause. Describe the hormonal changes and clinical features.
Definition
Menopause = the permanent cessation of menstruation resulting from loss of ovarian follicular activity, diagnosed retrospectively after 12 consecutive months of amenorrhoea.
- Average age 45–50 years (about 47 in India)
- Premature menopause — before 40 years
- Perimenopause (climacteric) — the transition, lasting 2–5 years
Hormonal Changes
| Hormone | Change | Reason |
|---|---|---|
| Oestrogen | ↓↓ | Follicles exhausted |
| Progesterone | ↓↓ | No corpus luteum |
| FSH | ↑↑↑ (> 40 IU/L) | Loss of negative feedback and of inhibin |
| LH | ↑↑ | Loss of feedback |
- FSH rises before LH and rises more, because inhibin is lost as well — a raised FSH is the biochemical marker
Clinical Features
| System | Features |
|---|---|
| Vasomotor | Hot flushes and night sweats — the commonest complaint; due to unstable hypothalamic thermoregulation |
| Genitourinary | Vaginal dryness, dyspareunia, atrophic vaginitis, urgency, recurrent urinary infection |
| Skeletal | Osteoporosis — the most serious consequence; rapid bone loss in the first 5 years |
| Cardiovascular | Loss of the protective effect of oestrogen → ↑ LDL, ↓ HDL → risk approaches that of men |
| Psychological | Irritability, insomnia, depression, poor concentration |
| Skin and breast | Thinning of skin, loss of breast tissue |
Osteoporosis
↓ Oestrogen → ↑ Osteoclast activity (↑ RANKL, ↓ osteoprotegerin) → Resorption exceeds formation → ↓ Bone mineral density → Fractures of vertebra, neck of femur, distal radius
Applied Aspects
- Hormone replacement therapy relieves vasomotor symptoms and prevents bone loss, but carries risks of breast cancer, thromboembolism and stroke. Current advice is the lowest effective dose for the shortest time
- Oestrogen alone must never be given to a woman with a uterus — unopposed oestrogen causes endometrial hyperplasia and carcinoma; a progestogen must be added
- Non-hormonal measures — calcium, vitamin D, weight-bearing exercise, stopping smoking, bisphosphonates
- Any bleeding after menopause is abnormal and must be investigated to exclude endometrial carcinoma
All questions in Reproductive System
- Q1Describe the ovarian and uterine changes of the menstrual cycle. Explain its hormonal control. ★
- Q2Define spermatogenesis. Describe its stages, the cells of the testis and the factors controlling it. ★
- Q3Describe the hormones of the placenta and the maternal physiological changes during pregnancy. Add a note on parturition. ★
- Q4Describe the actions and regulation of testosterone. Add a note on puberty in the male. ★
- Q5Describe the physiology of lactation. Explain why milk secretion begins only after delivery. ★
- SN1Describe the mechanism of ovulation and enumerate its indicators. ★
- SN2Classify the methods of contraception. Describe the mechanism of the combined oral contraceptive pill. ★
- SN3Define menopause. Describe the hormonal changes and clinical features. ★
- SN4Describe semen analysis with its normal values. Add a note on the composition of semen. ★
- SN5Describe the changes at puberty in boys and girls and the mechanism of its onset.
- SN6Describe the basis of pregnancy tests. Add a note on the causes of false results.
- SN7Define infertility. Enumerate its causes and outline the investigations. ★