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MENOPAUSE & PERIMENOPAUSE TRANSITIONJimmy Yanuar annas
Mata kuliah Dasar Fisiologi reproduksi
Matrikulasi IKR
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
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
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