WHAT ARE MENOPAUSAL, PERIMENOPAUSAL, AND POSTMENOPAUSAL HORMONE THERAPY?

WHAT ARE MENOPAUSAL, PERIMENOPAUSAL, AND POSTMENOPAUSAL HORMONE THERAPY?

  1. 1
    WHAT IS THE MEANING OF MENOPAUSE AND PERIMENOPAUSE?
    • Perimenopause begins with the onset of menstrual irregularity and ends 12 months after the last menstrual period, which marks the beginning of menopause. Menopause is the permanent cessation of menses caused by the loss of ovarian follicular activity. Women spend about 40% of their lives in postmenopause.
  2. 2
    WHAT ARE THE CAUSES OF MENOPAUSAL, PERIMENOPAUSAL SYMPTOMS?
    • The hypothalamic-pituitary-ovarian axis controls reproductive physiology. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH), produced by the pituitary in response to gonadotropin-releasing hormone from the hypothalamus, regulate ovarian function. Gonadotropins are also influenced by negative feedback from the sex steroids estradiol (produced by the dominant follicle) and progesterone (produced by the corpus luteum). Other sex steroids are androgens, primarily testosterone and androstenedione, secreted by the ovarian stroma.
    • As women age, circulating FSH progressively rises, and ovarian inhibin-B and anti-Mullerian hormone declines. In menopause, there is a 10- to 15- fold increase in circulating FSH, a 4- to 5-fold increase in LH, and a greater than 90% decrease in circulating estradiol concentrations.
  3. 3
    WHAT ARE THE SIGNS AND SYMPTOMS OF MENOPAUSE AND PERIMENOPAUSE?
    • Symptoms of perimenopause and menopause include vasomotor symptoms (hot flushes and night sweats), sleep disturbances, depression, anxiety, poor concentration and memory, vaginal dryness and dyspareunia, headache, sexual dysfunction, and arthralgia.
    • Signs include urogenital atrophy in menopause and dysfunctional uterine bleeding in perimenopause. Other potential causes of dysfunctional uterine bleeding should be ruled out.
    • Additionally, loss of estrogen production results in metabolic changes; increase in central abdominal fat; and effects on lipids, vascular function, and bone metabolism.
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