MENOPAUSE 1. The cessation of menses is menopause. The climacteric and perimenopausal are the periods of waning ovarian function
MENOPAUSE • 1.The cessation of menses is menopause.The climacteric and perimcnopausal are the periods of waning ovarian function
90 90 2.Female life expectancY 80 80 70 70 60 50 50 Age of menopause 40 850 1900 1950 2000 Age of menopause and female life expectancy
Age of menopause Age of menopause and female life expectancy. 2.Female life expectancy 1850 1900 1950 2000 40 50 60 70 80 90 90 80 70 60 50 40
3SYMPTOMS AND SIGNS OF OVARIAN FAILURE (1) Menstrual Cycle Alterations Soon after an adolescentwoman has her first menstrual cycle, regular, predictable menstrual cycles are established that continue until approximately 40 years of age. Around 40 years the number of ovarian follicles becomes substantially depleted and subtle changes occur in the frequency and length of menstrual cycles
3.SYMPTOMS AND SIGNS OF OVARIAN FAILURE (1) Menstrual Cycle Alterations Soon after an adolescentwoman has her first menstrual cycle, regular, predictable menstrual cycles are established that continue until approximately 40 years of age. Around 40 years, the number of ovarian follicles becomes substantially depleted and subtle changes occur in the frequency and length of menstrual cycles
A woman may note shortening or lengthening of her cycles. The luteal phase of the cycle remains constant at 13 to 14 days. whereas the variation of cycle length is related to a change in the follicular phase Women in their 20s and 30s ovulate 13 to 14 times per year. Several years in advance of menopause, the frequency of ovulation decreases to ll to 12times per year and with advancing reproductive age, may decrease to 3 to 4 times per year
• A woman may note shortening or lengthening of her cycles. The luteal phase of the cycle remains constant at 13 to 14 days, whereas the variation of cycle length is related to a change in the follicular phase. Women in their 20s and 30s ovulate 13 to 14 times per year. Several years in advance of menopause, the frequency of ovulation decreases to 11 to 12times per year and, with advancing reproductive age, may decrease to 3 to 4 times per year
With the change in reproductive cycle length and frequency there are concomitant changes in the plasma concentration of fsh andl. more FSH is required to stimulate follicular maturation. Beginning in the late 30s and early 40s, the concentration of FSH begins to increase. This is the frist chemical evidence of ovarain failure
• With the change in reproductive cycle length and frequency ,there are concomitant changes in the plasma concentration of FSH and LH . More FSH is required to stimulate follicular maturation .Beginning in the late 30s and early 40s, the concentration of FSH begins to increase . This is the frist chemical evidence of ovarain failure
The 5-to 10-year period before menopause is termed perimenopause. During the perimenopausal years, women begin to experience symptoms and signs of estrogen deficiency as reproductive function becomes increasingl inefficient. Realative change in FSH as a function of life are presented in Table 38.1
The 5- to 10-year period before menopause is termed perimvenopause.During the perimenopausal years, women begin to experience symptoms and signs of estrogen deficiency as reproductive function becomes increasingly inefficient. Realative change in FSH as a function of life are presented in Table 38.1
(2 )Hot Flushes and Vasomotor Instability Coincident with the change in reproductive cycle length and frequency, the hot flush is the first physical manifestation of ovarian failure Occasional hot flushes begin several years before actual menopause. The hot flush is the most common symptom of impending ovarian failure More than 95% of perimenopausal women experience hot flushes
(2)Hot Flushes and Vasomotor Instability Coincident with the change in reproductive cycle length and frequency, the hot flush is the first physical manifestation of ovarian failure. Occasional hot flushes begin several years before actual menopause. The hot flush is the most common symptom of impending ovarian failure. More than 95% of perimenopausal women experience hot flushes
(3)Sleep Disturbances Ovarian failure with consequent declining estradiol induces a change in a woman's sleep cycle so that restful sleep becomes difficult and for some impossible. The latent phase of Sleep(le, the time required to fall asleep) is lengthened; the actual period of sleep is shortened
(3)Sleep Disturbances • Ovarian failure with consequent declining estradiol induces a change in a woman’s sleep cycle so that restful sleep becomes difficult and for some, impossible. The latent phase of sleep(I.e,the time required to fall asleep) is lengthened; the actual period of sleep is shortened
Therefore, perimenopausal and postmenopausal women complain of having difficulty falling asleep and of waking up soon after going to sleep. This is one of the most disabling and least appreciated adverse effects of menopause The sleep cycle is restored to the premenopausal state by the administration of replacement estrogens
• Therefore,perimenopausal and postmenopausal women complain of having difficulty falling asleep and of waking up soon after going to sleep. This is one of the most disabling and least appreciated adverse effects of menopause. The sleep cycle is restored to the premenopausal state by the administration of replacement estrogens
(4)Vaginal Dryness and Genital Tract Atrophy The vaginal mucosa, cervix, endocervix endometrium, myometrium, and uroepithelium are estrogen-dependent tissues. With decreasing estrogen production. these tissues become atrophic, resulting in various symptoms. The vaginal epithelium becomes thin and cervical secretions diminish
(4)Vaginal Dryness and Genital Tract Atrophy • The vaginal mucosa, cervix, endocervix, endometrium, myometrium, and uroepithelium are estrogen-dependent tissues. With decreasing estrogen production, these tissues become atrophic, resulting in various symptoms. The vaginal epithelium becomes thin and cervical secretions diminish