Lec 19 - Endocrine & Reproductive Changes

What endocrine changes happen with aging? (3)

Decreased response of the hypothalamus and anterior pituitary

• Atrophy of the pituitary

  • Decreased secretions

Non-tropic glands

• Atrophy and fibrosis

• Decreased hormone release

  • Also decreased break-down

Decreased sensitivity of target organs

how do hormone levels change with aging? **exam

all hormones go down with aging except cortisol and insulin (they both increase)

What is ADH?

Anti-diuretic hormone

What happens with decreased levels of ADH? (3) at night?

Can’t concentrate the urine

Higher urine output

Dehydration

Doesn’t increase at night as much

• Nocturia (night time urination)

What happens to thyroid hormone with aging? what does that result in?

Decreased levels with aging

• Hypothyroidism more common in women

• Auto-immune in 3-4% of people over 65

• Thyroid often enlarges (goiter)

  • Inflammation response

growth hormone with aging? results in? (4)

GH decreases by 50+% by age 65 (compared to age 20)

Results in

• Cellular aging and necrosis

• Muscle atrophy (sarcopenia)

• Decreased bone (osteoporosis)

• Thinner skin

what might GH be responsible for according to a study?

GH might be responsible in part for decreased muscle and bone in elderly

What are effects of GH treatment?

increased mortality…

Attributed to:

• Decreased immune function

• Increased insulin resistance

• Multi-Organ Failure

What happens to cortisol with age and why? where is cortisol made?

Cortisol levels rise with age (due to decreased removal)

Adrenal Gland makes cortisol

How does body respond to high levels of cortisol?

Decreased response to hormone

• Reduced immune response

• Less able to handle stressors

• May contribute to dementias

Increased aging of neurons?

What is another hormone made by adrenal glans? What happens to it?

Aldosterone

• less as aging

  • may cause Na+ imbalance and increased urine

Why does insulin increase with age? Body response?

Insulin levels rise with age

• Reduced removal

• Reduced response

• Pancreas inflammation

Cells less responsive

• Type II diabetes

What happens to female reproduction with aging?

A woman’s reproductive potential decreases with age

• Decline starts after age 30

• Reproductive potential lost well before menopause

What happens to miscarriage rates?

Increase with aging

What is happening to women and conceiving? Why?

Women having children later in life

1/3 of women aged 35+ have problems conceiving

< 30% of women aged 40+ conceive naturally

Why?

• Quality of oocyte declines with age

• FSH increases with age - difficulty conceiving

  • If they do, miscarriage is more likely

What oocyte changes happen with aging?

Declining Follicular Reserve

Change in microtubule and chromosome placement in meiosis

• Increased aneuploidy (unbalanced chromosomes) seen in offspring of older women

• Eg. Down’s Syndrome

What is menopause?

Halting of menstruation

• ages 45 – 55

Decreased estrogen / FSH

• 35% by age 40

• 95% by age 55

Menopause symptoms? (5)

Hot flashes

Night sweats

Vaginal dryness

Depression

Sleep disorders

What changes can happen to menstrual flow?

Changes inflow and frequency are common:

• Lighter bleeding

• Heavier bleeding •

  • Blood clots

• Duration of bleeding

• Cycle length Skipped menstrual periods

What is abnormal uterine bleeding (AUB)?

Abnormal uterine bleeding (AUB) if:

• If blood loss more than 100 mL (plus mucous)

• Bleeding last more than 7 days

• If time between bleeding is <21 days

What are hot flashes like? How common?

75% of menopausal women experience hot flashes

• 5-10 years…..can continue

• Often at night – night sweats

What kind of a response is hot flash?

Vasomotor response

• Sympathetic – increase body temp

  • Higher heart rate

  • Vasodilation

    • face and neck

  • Sweating

What happens to estrogen with aging? Result of this? (6)

Estrogen changes (decrease) in menopause result in:

• Increased fat, decreased muscle

• Decreased bone strength

• Elevated cholesterol (CV disease)

• Atrophy in the labia, clitoris, and vagina

• Vaginal Dryness, increased infections

• Uterus, fallopian tubes and ovaries become smaller – more fibrotic

What does estrogen + progestin hormone replacement therapy increase risk of? (5) Decrease risk of? (3)

Increases Risk of:

• Breast Cancer

• Heart Disease

• Stroke

• Blood Clots

• Dementia

Decreased Risk of:

• Hip Fractures (Osteoporosis)

• Colon Cancer

• Relieves symptoms of menopause

What are other treatments for menopause? (7)

Sleep aids / anti-depressants / melatonin

Iron (to help with iron loss with bleeding) / vitamins

Topical progesterone

Herbal meds – St. John’s wort, cranberry, etc.

Avoid hot flash triggers

• caffeine, alcohol, spicy food

Keep cool

• Dress in layers / cool rooms / cold drinks / fans

Reduce sexual and vaginal discomfort

• lubricants

Does exercise help with menopause? What kind?

No conclusive study on whether exercise can reduce the symptoms

• But general health benefits should help the transition

• Women report symptoms decrease with exercise

Relaxation exercises

Pelvic floor exercises

Proper diet

What is uterine prolapse? Symptoms? (4) Treatment? (2)

Uterus protrudes into vagina

Symptoms:

• Heaviness in pelvis

• Urinary stress

• Dysuria

• Low back pain

Treatment:

• Hysterectomy

• pessary

What is vaginal prolapse? How?

Vagina everts

• often after hysterectomy

What are treatments for prolapses? (2)

Removable pessaries

• Hold organs in place

Surgical meshes

What is cystocele? Symptoms? (3)

Herniation (protusion) of urinary bladder through anterior vaginal wall

Symptoms:

• Pelvic pressure

• Urinary urgency

• incontinence

What is rectocele? Symptoms? (3) treatment?

Herniation of rectum through posterior vaginal wall

Symptoms:

• Discomfort

• Constipation

• Fecal incontinence

Treatment:

• Surgical repair

Menopause vs Andropause symptoms?

Maximal symptoms peak at age 50 for both

What is andropause?

Aging of the male reproductive system

Decrease in testosterone

• 1% / year after age 30

Male function may remain normal until 80

What is andropause associated with? (4)

Associated with

• Impotence

• Gynecomastica

• Hypertrophic prostate

• Testicular and prostate cancer

What happens to male fertility with aging? (3)

Loss of libido

Reduced blood flow to penis

Number and motility of sperm decrease

• Decreased volume of ejaculate

• Less forceful ejaculation

• Longer refractory period (“reset” time)

What happens If a male partner is >50 years in terms of conceiving?

If a male partner is >50 years, fertility decreases and rate of miscarriage increases

• Age of both partners is important

What is benign prostatic hyperplasis?

Growth of prostate from age 40 to death

• Affects 50% of men over 50

• Affects 95% of men over 70

Obstruction of urethra

RF for benign prostatic hyperplasia? (7) What can this condition be a higher risk for?

Aging

Use of anabolic steroids

Genetic predisposition

Environmental toxins

Smoking, alcohol

Sexually transmitted diseases

Diet (high animal fats)

Higher risk for prostate cancer

Who develops prostate cancer?

Most men develop prostate cancer in old age

How to reduce risk of prostate cancer?

Frequent Ejaculation May Reduce Risk of Prostate Cancer

• Men with more than 20 monthly ejaculations was 33 percent less likely to develop prostate cancer

Activity may flush out toxins in the prostate

• Less crystallization

What is erectile dysfunction? Causes? (7)

Inability to get or maintain an erection

Causes

• Aging and disease

  • Kidney failure, liver failure, CV failure \

• Psychological

• Neural or endocrine

• Vascular (leading cause)

• Drug-induced

• Obesity and Diabetes

• Smoking

What can really increase rates of erectile dysfunction?

Rates are higher with smoking and alcohol

Higher rates with stress and hypertension

Higher rates with obesity

Treatments for erectile dysfunction? (6)

Medications (eg. Viagra, Cialus)

Lose weight, stop smoking

Change hypertension meds (some are causal)

Surgery

Implants

Injections, gels

How does Viagra/Cialis work?

Inhibit the break-down of Nitric oxide

• So prolonged vasodilation effect

Studies showed lower blood pressure

Viagra/Cialis effect on Alzheimer?

Good effects for Alzheimer’s disease

• decrease in disease

• less tangles and plaques

• less inflammation

• better cognitive function

What can cause sexual dysfunction among older people? (6)

Medical conditions can cause sexual dysfunction among older people, including:

• Heart Disease

• Diabetes

• Depression

• Breast and prostate cancers

• HIV/AIDS

• Dementia

Relationship between heart disease and sexual health?

In a study of postmenopausal women the presence of coronary heart disease was significantly associated with

• lack of sexual interest

• inability to relax during sexual activity

• arousal and orgasmic disorders

• general discomfort with sex

For men

• ED prevalent with heart disease

• decline in sexual activity

Diabetes and sexual health?

40% of diabetes over age 65 report sexual dysfunction

• Erectile dysfunction

• Orgasm

Pelvic floor exercise and sexual dysfunction?

Helps to strengthen the bulbocavernosus muscle

• Allows the penis to fill with blood during erection

• Pumps during ejaculation

• Helps empty the urethra after urination

Aerobic exercise and sexual dysfunction?

Aerobic exercise

• Improves blood flow (ED and orgasms)

• Decreases obesity

• Improves general cardiovascular health

This will result in reduced sexual dysfunction

30 minutes; 3-4 times per week