endo

The menopuase

• progressive decline in ovarian function
• symptomology due to loss of oestrogen - oophorectomy
• marked by end of mensturation - 12 months after last period
• FSH high, oestrogen low

symptomology

• vasomotor disturbances

1. flushing, peripheral vasodilation
2. nocturnal sweating and sleep problems
3. headaches

• urogenital atrophy

1. wall of vagina thins and glands atrophy - reduced mucus
2. similar changes in urethra and bladder - frequency and dysuria

• physiological effects

1. memory 
2. mood and affect
3. long term neurodegenration - alzhiemers

• osteoporosis

1. bone density decrease, deterioration of structure
2. risk factors : white, smokers, low physical excercise, inadequate dietary Ca2+
3. FRACTURES

HRT

replacement of hormones

• oestrogen 

1. loss gives rise to symptoms
2. risk of endometrial hyperplasia and carcinoma

-synthesised natural oestrogens

-natural oestrogens from equine sources

• progesterone: used in combination

1. used in women with an intact uterus
2. withdrawl from progesterone causes bleeding

benefits

• vasomotor and physiological:-

1. reduction in flushing, sleep broblems, sweats, headaches, palpitations
2. very distressing : physiological benefit when reduced

• urogenital ageing

1. reduction in vaginal dryness : vaginal &urethral infections
2. reduction in dysuria and urinary frequency
3. replacing oestrogen helps regardless of route of admin

• osteoporosis

1. HRT delays bone loss and increasses none density in hip and spine - BUT needs to be taken for 7-to 10years
2. effects wane rapidly on cessation
3. oral and transdermal equally effective
4. long term therapy licensed for prevention of osteoporosis

• colorectal cancer

1. reduction in incidence dependent on age of cohort and duration of treatment

• coronary heart disease

1. normal incidence rises post menopuase
2. many studies but difficult to control all other…