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==<big>Overview</big>==
 
==<big>Overview</big>==

Latest revision as of 19:09, 2 August 2020

Menopause Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Epidemiology and Demographics

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Other Imaging Findings

Treatment

Medical Therapy

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Menopause pathophysiology On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Menopause pathophysiology

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Menopause pathophysiology

CDC on Menopause pathophysiology

Menopause pathophysiology in the news

Blogs on Menopause pathophysiology

Directions to Hospitals Treating Menopause

Risk calculators and risk factors for Menopause pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Editor-In-Chief: Rahmah Al-Edresi, M.D.

Overview

Menopause is natural amenorrhea that is happened without any pathological causes, but premature menopause caused by pathological diseases, that are lead to early cessation of menses.

Pathophysiology

physiological menopause:

Menopause happens normally as women age, And the main cause of the menopause is the natural depletion of the primary follicles (oocytes) in the ovaries and And the decline of the response of ovaries to anterior pituitary gonads hormones that include Follicle Stimulating Hormone (FSH) and Luteinizing Hormone(LH). These hormones stimulate the ovaries to produce estrogen and progesterone hormones in a cyclic pattern under the control of the hypothalamus that produces the gonadotropin-releasing hormones which stimulate anterior pituitary gonads hormone secretion and inhibin-B that plays role in feedback mechanism. "During perimenopause (approaching menopause), estradiol levels and patterns of production remain relatively unchanged or may increase compared to young women, but the cycles become frequently shorter or irregular. The often observed increase in estrogen is presumed to be in response to elevated FSH levels that, in turn, is hypothesized to be caused by decreased feedback by inhibin".[1] "Characteristic changes in the hypothalamic-pituitary-ovarian (HPO) axis during the menopause transition result from decreased ovarian feedback of inhibin and estradiol and are manifested primarily as elevations in follicle-stimulating hormone (FSH). Although central mechanisms may contribute to reproductive aging, they are less well characterized. Adrenal changes concurrent with the menopause transition include elevations in serum cortisol and transient elevations in dehydroepiandrosterone sulfate, androstenediol, and other adrenal androgens"[2]. Post-menopause can be determined by a blood test that can reveal the very high levels of Follicle Stimulating Hormone (FSH) that are typical of post-menopausal women.

pathological menopause:

premature or early menopause induced by pathological disease in ovaries such as polycystic ovary syndrome, due to excessive secretion of androgen from ovaries lead to irregular cycle or amenorrhea. And autoimmune diseases, the body’s immune system attacks the ovaries and keeps them from making hormones. Premature ovarian failure is the loss of ovarian function lead to amenorrhea because of ovarian failure to respond for gonads hormone ( FSH, LH) and deficiency production of estrogen and progesterone. Ovarian tumor or endometriosis that is required surgical intervention as Bilateral oophorectomy or salpingo-oophorectomy, the menstrual cycle will stop after this surgery, and hormone levels will drop quickly with strong menopausal symptoms. Bilateral oophorectomy sometimes was done with Hysterectomy.

Hysterectomy does not itself cause menopause, although pelvic surgery can sometimes precipitate somewhat earlier menopause, perhaps because of compromised blood supply to the ovaries, women who have undergone hysterectomy with ovary conservation go through menopause 3.7 years earlier than average.[3]

Genetic

  • Fragile X syndrome gene is a genetic disorder characterized by reduction of ovarian function, women that have fragile x syndrome go through early menopause an average 5 years early than other women.
  • Turner’s syndrome: Women born with missing chromosomes or problems with chromosomes can go through menopause early, women are born without all or part of one X chromosome, so their ovaries do not form normally at birth and their menstrual cycles, including the time around menopause, may not be normal.

Menopause Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Epidemiology and Demographics

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Other Imaging Findings

Treatment

Medical Therapy

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Menopause pathophysiology On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Menopause pathophysiology

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Menopause pathophysiology

CDC on Menopause pathophysiology

Menopause pathophysiology in the news

Blogs on Menopause pathophysiology

Directions to Hospitals Treating Menopause

Risk calculators and risk factors for Menopause pathophysiology

Associated Conditions[edit | edit source]

  • The most important Conditions associated with Menopause include:
  1. Cardiovascular disease: " Estrogen has a positive effect on the tunica intima of the artery wall, helping to keep blood vessels flexible. During menopause, estrogen deficiency causes vasoconstriction of the vessel wall and an accelerated increase of low-density lipoprotein (LDL). Thus, menopause is linked to the increased risk of cardiovascular disease".
  2. Osteoporosis is a disease of the bones that causes bones to become weak and break easily." During menopause, estrogen deficiency increases osteoclastic activity, such that there is an imbalance of osteoclastic and osteoblastic activity. This results in more bone being reabsorbed and overall bone loss.  Estrogen deficiency leads to the release of cytokines among them RANKK ligand (RANKL), which plays a critical role in the osteoclastogenesis cascade. During menopause, women experience an increased rate of bone loss of 3% to 5% per year for 5 to 7 years".[4]


Microscopic Pathology

On microscopic histopathological of menopause," Structures of the ovaries ( cortex and medulla) are change, the distinction between the cortex and medulla is less evident The cortex becomes thinner, it has fewer follicles that is the tendency towards the fragmentation of the corpora arenacea. Additionally, there are invaginations of the surface epithelium of the cortex, and epithelial inclusion cysts are present. The medulla develops stromal fibrosis and scars. The medulla also undergoes the hyalinization of vessel walls, with architectural changes of vessels. There is also a significant change in the vagina during menopause, the mucosa layer of the vagina begins to atrophy due to decreased estrogen that causes this cell layer to become drier and thinner. As a result, the vaginal mucosa loses its elasticity and becomes fragile".[5]






References