menopause. pptx

A natural decline in reproductive hormones when a woman reaches her 40s or 50s.
Menopause is signalled by 12 months since last menstruation.
Common symptoms include hot flashes and vaginal dryness. There may also be sleep disturbances. The combination of these symptoms can cause anxiety or depression.
Menopause is a natural process with treatments that focus on symptomatic relief. Vaginal dryness is treated with topical lubricants or oestrogen. Medications can reduce the severity and frequency of hot flushes. In special circumstances, oral hormone therapy may be used.

1. MENOPAUSE Dr. K. Ambareesha PhD,. Assistant Professor, Department of Physiology, GMC, Secunderabad , Telangana

2. Specific learning objectives Define Menopause Menopausal syndrome Physical changes in menopause Post menopausal changes in ovarian steroids and gonadotrophins. Physiological basis, benefits and risks of Hormone replacement theory (HRT)

3. Define Menopause refers to the termination of reproductive function in women . Mean age of menopause is 51-54 yrs

4. 2. The Menopausal Syndrome and Physical Changes in Menopause

5. The Menopausal Syndrome and Physical Changes in Menopause

6. Post menopausal changes in ovarian steroids and gonadotrophins

7. The loss of functional ovarian follicles is primary responsible for menopause. Because of gradual decline in the no of follicles , the decreased ovarian production of estrogen reduces the negative feedback to ant. Pituitary and leads to increased level of FSH. Increased level of FSH are seen as early as 35 years of age.

8. Older or Premenopausal women have diminished estradiole production and decreased luteal function natural cycles. Ovarian production of androstendione is minimal during menopause, negative feedback on the hypothalamic pituitary ovarian axis becomes minimal (fig).

9. Number of primordial follicles per ovary in women at various ages. Blue squares, premenopausal women (regular menses); red squares, perimenopausal women (irregular menses for at least 1 year); red triangles, postmenopausal women (no menses for at least 1 year). Note that the vertical scale is a log scale and that the values are from one rather than two ovaries.

10. Hormonal changes during the menstrual cycle. The menstrual cycle is a cycle of the hypothalamic-pituitary-ovarian axis, as well as a cycle of the targets of the ovarian hormones: the endometriumof the uterus. Therefore, the menstrual cycle includes both an ovarian cycle—which includes the follicular phase, ovulation, and the luteal phase—and an endometrial cycle—which includes the menstrual, the proliferative, and the secretory phases.

11. Hypothalamic-pituitary-ovarian axis. Smallbodied neurons in the arcuate nucleus and the preoptic area of the hypothalamus secrete GnRH , a decapeptide that reaches the gonadotrophs in the anterior pituitary through the long portal veins. GnRH binds to a G- proteincoupled receptor on the gonadotroph membrane, triggering the IP3/DAG pathway, raising [Ca2+] i and phosphorylation . Stimulation causes the gonadotrophs to synthesize and release two gonadotropins —FSH and LH—that are stored in secretory granules. Both FSH and LH are glycoprotein heterodimers comprising common α subunits and unique β subunits. The LH binds to receptors on theca cells, thus stimulating Gαs , which, in turn, activates adenylyl cyclase . The resultant rise in [ cAMP ] i stimulates protein kinase A (PKA), which increases the transcription of several proteins nvolved in the biosynthesis of progestins and androgens. The androgens enter granulosa cells, which convert the androgens to estrogens. The dashed arrow indicates that the granulosa cells also have LH receptors. FSH binds to receptors on the basolateral membrane of granulosa cells, also activating PKA, thereby stimulating gene transcription and synthesis of the relevant enzymes (e.g., aromatase ), activins , and inhibins . Negative feedback on the hypothalamic- pituitary-ovarian axis occurs by several routes. The activins and inhibins act only on the anterior pituitary. The estrogens and progestins act on both the anterior pituitary and on the hypothalamic neurons, by exerting both positive and negative feedback controls. CNS, central nervous system.

12. Gonadotropin function during life. A, The levels of both LH and FSH peak during fetal life and again during early infancy, before falling to low levels throughout the rest of childhood. At the onset of puberty, LH and FSH levels slowly rise and then begin to oscillate at regular monthly intervals. At menopause, gonadotropin levels rise to very high levels. The four insets show daily changes in gonadotropin levels

13. Physiological basis, benefits and risks of Hormone replacement theory (HRT)

14. HRT Increased level of FSH occurs as early as 35yrs of age. The increase in gonadotrophin secretion is probably a result of decreased folliculogenesis leading to decreased secretion of sex steroids and inhibin and thus lowerd negative feedback on the gonadotrophins during the premenoausal period.

15. The characteristic changes assosiacted wit menopause are primarly the result of low circulating estrogen levels. Estrogen is very imp regulatory hormone in girls and women. In addition to the role of estrogen in reproductive process, this hormone has profound effects on several other physiological system (fig)

16. The Selective ER modulators (SERMS) Comprise a group of structurally dissimilar compounds that interact with ERS. However, these agents act as either estrogen anonists or estrogen antagonists, depending on the target tissue and hormonal status of the individual.

17. The exact mechanism through SERMS elicit their effects on specific tissues remain unclear and constitute an area of active research. The etrogen antagonists effects of SERMS may be mediated by the classic competition for the ER.

18. For example. The effect SERM would alleviate the menopausal syndrome, present against cardiovascular and Alzheimer disease and act as estrogen agonists in certain reproductive tissue and as antagonists in others.

19. References Ganong Boron Williams Obstetrics