MENOPAUSE. 1.The cessation of menses is menopause.The climacteric and perimcnopausal are the periods of waning ovarian function. 90. 90. 2 .Female life expectancy. 80. 80. 70. 70. 60. 60. 50. 50. Age of menopause. 40. 40. 1850. 1900. 1950. 2000.
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2.Female life expectancy
Age of menopause
Age of menopause and female life expectancy.
(1) Menstrual Cycle Alterations
Soon after an adolescentwoman has her first menstrual cycle, regular, predictable menstrual cycles are established that continue until approximately 40 years of age. Around 40 years, the number of ovarian follicles becomes substantially depleted and subtle changes occur in the frequency and length of menstrual cycles.
A woman may note shortening or lengthening of her cycles. The luteal phase of the cycle remains constant at 13 to 14 days, whereas the variation of cycle length is related to a change in the follicular phase. Women in their 20s and 30s ovulate 13 to 14 times per year. Several years in advance of menopause, the frequency of ovulation decreases to 11 to 12times per year and, with advancing reproductive age, may decrease to 3 to 4 times per year.
With the change in reproductive cycle length and frequency ,there are concomitant changes in the plasma concentration of FSH and LH . More FSH is required to stimulate follicular maturation .Beginning in the late 30s and early 40s, the concentration of FSH begins to increase . This is the frist chemical evidence of ovarain failure.
The 5- to 10-year period before menopause is termed perimvenopause.During the perimenopausal years, women begin to experience symptoms and signs of estrogen deficiency as reproductive function becomes increasingly inefficient. Realative change in FSH as a function of life are presented in Table 38.1.
Coincident with the change in reproductive cycle length and frequency, the hot flush is the first physical manifestation of ovarian failure. Occasional hot flushes begin several years before actual menopause. The hot flush is the most common symptom of impending ovarian failure. More than 95% of perimenopausal women experience hot flushes.
Therefore,perimenopausal and postmenopausal women complain of having difficulty falling asleep and of waking up soon after going to sleep. This is one of the most disabling and least appreciated adverse effects of menopause. The sleep cycle is restored to the premenopausal state by the administration of replacement estrogens.
Women experience vaginal dryness while attempting or having sexual intercourse, leading to diminished sexual enjoyment and dyspareunia. Atrophic vaginitis also may present with itching and burning. The thinned epithelium is also more susceptible to becoming infected by local flora.
The physician should provide counseling and emotional support as well as medical therapy. The role of estrogons in central nervous system function is unknown. However, it is well established that sex steroid hormone receptors are present in the central nervous system. Estrogen replacement in perimenopausal and postmenopausal women often diminishes these mood swings.
All of the signs and symptoms, and adverse effects, of menopause result from declining estradiol-17B production by the ovarian follicles. Exogenous estrogen adminstration to the perimenopausal and postmenopausal woman obviates most of these changes. Estradiol-17B and its metabolic byproducts, estrone and estriol, are used for replacement.