MENOPAUSE & PERIMENOPAUSE TRANSITIONJimmy Yanuar annas

Mata kuliah Dasar Fisiologi reproduksi

Matrikulasi IKR

PROBLEM MENOPAUSE

PERIMENOPAUSAL TRANSITION DEFINITION There is only one marker Menstrual irregularity

PERIMENOPAUSAL PERIODE

PERIMENOPAUSAL PERIODE Continuing and accelerating follicular depletion begin at age 37-38

When women are in their 40’s anovulation bicome prevalent, menstrual cycle

length increases Unopposed estrogen Cause ? Risk ?

Beginning in 2-8 years prior to menopause

Estradiol levels do not gradually wane before menopause slightly elevated until

about 1 year before menopause

High estradiol levels corresponds to high FSH level during perimenopause periode

Low Inhibin B reflect the remaining follicles in the aging ovary

PERIMENOPAUSAL PERIODE

PROBLEM OF ESTROGEN EXCESS Significant increase incidence of Dysfunctional uterine bleeding 20%

cycles

Cause of increase estrogen level Anovulatory & Extragonadal

endogenous estrogen production ( Tumors , adipose tissue and Decrase

liver function)

Consider endometrial biopsy when endometrial thickness is 5-12 mm or

presence of risk factors

The use of estrogen progestin contraception can provide contraception and

prophylaxis against irregular bleeding, endometrial hyperplasia and cancer

MENOPAUSE

Menopause the point of time where permanent cessasation of

menstruation occurs following loss of follicular activity

Age of menopause 50-52 year of age (51,3 years )

Factors :

BMI, life style ( smoking, alcohol ), history of cystectomy, chemotx , radiation,

PCOS

Race, age of menarche, height, physical activity

HORMONE PRODUCTION AFTER MENOPAUSE

HORMONE PRODUCTION AFTER MENOPAUSE

EFFECT OF POSTMENOPAUSAL ESTROGEN DEPRIVATION Vasomotor problems ( Hot flush )

Perimenopausal 20% Menopausal 60% Other causes : thyroid disease, stress, carcinoid, cancer, leukemia,

psichosomatic

Atropic changes Dysparunia Sexual activity changes Vaginal pH changes ( > 4.5) recurrent infection Stress incontinence urethral mucosa atrophy

Psychophysiologic problem mood difficulities Some women are greater risk of mood problem underlying problems +

enhanced by vasomotor symptoms 85 % women had menopause without mood dificulities

Cognition & Alzheimer disease

Cardiovascular disease Due to artherosclerosis Risk factors: Family history, high blood pressure, smoking, DM, abnormal lipid

profile and obesity

Osteoporosis Spinal compression fracture Colles fracture Head of femur fracture Tooth loss

EFFECT OF POSTMENOPAUSAL ESTROGEN DEPRIVATION

Risk factor for osteoporosis Age double every 7-8 years Previous history of fragile fracture Smoking Being thin and small framed History of osteoporosis in family Amenorhea ( hypoestrogenism Lifelong deficient calcium and Vit D Sedentary life style Excessive use of alcohol

EFFECT OF POSTMENOPAUSAL ESTROGEN DEPRIVATION