Endocrinology Hormone Replacement Therapy REVISE THE HPG What would happen without oestrogen? Ovulate 400 times in a life By the time we reach menopause we have no developing follicles; no oestrogen. The Menopause It is not a problem as such, the problem comes from the lack of oestrogen, which causes the symptoms and the long term effects. It starts in women of varying ages, by usually between mid 40s and 50s - average is 52. Go through a period of gradual decline, where we start to have irregular periods, where some months we ovulate. The disruption to periods can be 5-10 years window frame. Progressive decline in ovarian function - 2-3 years - confident that there are no eggs left after this time period. Symptomology due to loss of oestrogen - Natural decline - oophorectomy Marked by end of menstruation - 12 months after last period During this period of decline there is high FSH levels and low oestrogen levels - this is during the perimenopause. Symptomology Oestrogen affects the central nervous system and the way it causes peripheral effects. Vasomotor Disturbances - the way the nerves cause effects - Flushing, peripheral vasodilatation - Nocturnal sweating (drenched) and sleep problems - headaches Its how you cope with the symptoms that is the problem. Urogenital Atrophy - Wall of vagina thins and glands atrophy - this is because oestrogen was used to maintain the uterine lining and glands to have sex, but after we loose it, we don't have the maintenance anymore. - also reduced mucus
Endocrinology - The urethra and bladder is affected too; we find we have more infections and have incontinence issue: increased frequency and dysuria Psychological Effects - Memory - bad - Mood and affect - massive PMT (treated for anxiety and depression) - Long term neurodegeneration: Alzheimers Osteoporosis - Bone Density, deterioration of structure - Risk factors: white, smokers, low physical exercise, inadequate dietary Caffff - FRACTURES Oestrogen has the role of maintaining bone minerals, when we loose the oestrogen, we leach all of the calcium from the bones and weaken the bones. We are living longer and because oestrogen has this role, we struggle to support ourselves with the bones. HRT REPLACEMENT of hormones - Oestrogen - Loss gives rise to symptoms - Risk of endometrial hyperplasia and carcinoma - if given oestrogen on its own to the woman with a uterus, it is pushing the cells, and the lining is not being shed, there is an increased risk of uterine cancer We want to give oestrogen as we want to get rid of symptoms, so we combine it with progesterone for those woman with a uterus. - Progesterone: used in combination to allow for the shedding of the uterine wall; reduces risk of uterine cancer! o Used in women with an intact uterus o Withdrawal from progesterone causes bleeding Oestrogen and progesterone lack after the menopause, therefore we can replace them. Oestrogen on its own for woman without uterus is okay. Benefits of HRT