Menopause

Overview 

• Menopause
  • signals end of menstrual cycles and reproductive function in females
  • progressive loss of ovarian follicle units (atresia) throughout reproductive life causes a decrease in ovarian production of estrogen and reduces negative feedback to anterior pituitary, leading to an increase in FSH and LH levels
  • typically preceded by several years of abnormal menstrual cycles
    • e.g., anovulatory cycles
  • diagnostic findings include ↓ estrogen, ↑↑ FSH, ↑ LH, ↑ GnRH  
  • in post-menopausal women, source of estrogen includes ovary and adrenal cortex
    • via peripheral aromatization of androgens
      • adrenal cortex (major) and ovary (minor) are sources of androstenedione
        • ↑ androgens result in a male pattern hair growth (mainly on the face)
  • average age of menopause is 50 years
    • onset early in smokers
    • early menopause may indicate premature ovarian failure
• Menopause symptoms 
  • symptoms are caused by loss of ovarian source of estrogen
    • male-pattern hair growth in women via ↑ androgens
    • hot flashes (vascular instability)
    • atrophy of vagina (thinning of vaginal epithelium)
    • ↓ vaginal secretions
    • osteoporosis
    • coronary artery disease