PATHOLOGY ASSOCIATED WITH MENOPAUSE. HORMONE REPLACEMENT THERAPY (HRT). PUBERTY AND ITS DISORDER

________ is recognized after 12 consecutive months of amenorrhea, for which no other pathological or physiological cause is evident

menopause

average age of menopause

>50y

premature vs early ovarian insufficiency age

premature - <40y

early 40-45y

short term effects menopause

• vasomotor - hot flashes, night sweats

• dyspareunia, decreased libido

• depression, anxiety, irritable, lethargic

long-term effects menopause

osteoporosis + fx (distal radius, femoral neck, vertebrae)

coronary disease

urogenital atrophy

menopause: when is FSH testing necessary

<40y and doubtful

levels FSH indicative of menopause

>30IU/L

HRT indications

menopause - hot flashes, osteoporosis, locally for vaginal symptoms

Menopause: Types of Systemic Estrogen-Based Treatments

• estrogen (for hysterectomy patients)

• estrogen + progesterone

  • cyclic if perimenopause

  • continuous during postmenopause

estrogen related side effects HRT (in menopausal women)

fluid retention, breast tendr, nausea

increased risk thromboembolism

progesterone related side effects HRT (in menopausal women)

mood changes

acne

pelvic pain

benefits HRT for menopausal women

• reduces symptoms

• reduces risk osteoporosis and colorectal cancer

risks of HRT for menopausal women

increases risk breast and endometrial cancer, thromboembolism and gallbladder disease

who gets earlier onset puberty

black girls, obese, high socio-economic status

The first somatic change in girls is usually the development of

breasts

ovarian hormone secretion (of mainly estrogens) leads to what changes during puberty

fat in mons pubis and labia majora

hymen thickens, clit increases, perineum elastic, vaginal mucosa thicker, pink

uterus and ovary volume increases

Increased secretion of _________ from the adrenal gland (adrenarche) leads to the appearance of pubic hair.

DHEA-S

average age menarche onset

<13y

body changes following menarche

increase bone mineral density, adipose tissue

precocious puberty

secondary sex characteristics <8yrs + advanced skeletal maturation

2 forms precocious puberty

gonadotropin-dependent (central) - idiopahtic or cns tumours

independent (Peripheral) - adrenal/ovarian tumours

investigations for dg precocious puberty

• bone age assessment

• pelvic US, cranial and abd imaging

• hormone profile (estradiol, fsh, lh, testo, dhea-s, 17-hydroxyprogesterone)

ttt of central precocious puberty

GnRH analogs, progestins

McCune-ALrbight sd ttt

testolactone

ketoconazole

Heterosexual precocity due to congenital adrenal hyperplasia (CAH) ttt

glucocorticoid therapy

GnRH analogs

causes virilization/heterosexual dev in girls

21-hydroxylase, 3β hydroxysteroid dehydrogenase, or 11β-hydroxylase deficiencies

adrenocortical adenomas or virilizing ovarian tumors

causes delayed puberty (>13y)

• hypogonadotropic hypogonadism from deficiencies fsh, lh, kallmann sd

Hypergonadotropic Hypogonadism (high fsh lh, low estradiol) occurs in the context of

• ovarian dysgenesis

• primary ovarian insufficiency