扬州大学：《妇产科学》课程教学课件（PPT讲稿）40 绝经期MENOPAUSE

MENOPAUSE1.The cessation of menses ismenopause.The climacteric andperimcnopausal are the periods of waningovarian function

MENOPAUSE • 1.The cessation of menses is menopause.The climacteric and perimcnopausal are the periods of waning ovarian function

90902.Femalelife expectancy8080707060605050Ageofmenopause40401850190019502000Age of menopause and female life expectancy

Age of menopause Age of menopause and female life expectancy. 2.Female life expectancy 1850 1900 1950 2000 40 50 60 70 80 90 90 80 70 60 50 40

3.SYMPTOMSANDSIGNSOF OVARIAN FAILURE(1) Menstrual Cycle AlterationsSoon after an adolescentwoman has her firstmenstrual cycle,regular,predictablemenstrualcycles are established that continue untilapproximately 40 years of age. Around 40 yearsthe number of ovarian follicles becomessubstantially depleted and subtle changes occurin the frequency and length of menstrual cycles

3.SYMPTOMS AND SIGNS OF OVARIAN FAILURE (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 orlengthening of her cycles. The luteal phaseof the cycle remains constant at 13to 14days, whereas the variation of cycle lengthis related to a change in the follicular phaseWomenintheir20sand30sovulate13to14times peryear. Several years inadvanceof menopause, the frequency of ovulationdecreases to 11 to 12times peryear andwith advancing reproductive age, maydecrease to 3to 4timesper year

• 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 changein reproductive cyclelength and freguency ,there areconcomitant changes in the plasmaconcentration of FSH and LH.MoreFSH is required to stimulate follicularmaturation .Beginning in the late 30sand early 4Os,the concentration ofFSH begins to increase .This is thefrist chemical evidence of ovarainfailure

• 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 beforemenopause is termedperimvenopause.During theperimenopausal years, women begin toexperience symptoms and signs ofestrogen deficiency as reproductivefunction becomes increasinglyinefficient. Realative change in FSH asa function oflife are presented in Table38.1

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

(2)Hot Flushes and VasomotorInstabilityCoincident with the change in reproductive cyclelength and frequency, the hot flush is the firstphysical manifestation of ovarian failureOccasional hot flushes begin several years beforeactual menopause. The hot flush is the mostcommon symptom of impending ovarian failureMore than95%of perimenopausal womenexperience hot flushes

(2)Hot Flushes and Vasomotor Instability 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

(3)Sleep Disturbances Ovarian failure with consequentdeclining estradiol induces a change in awoman's sleep cycle so that restful sleepbecomes difficult and for some.impossible.The latent phase ofsleep(I.e,the time required to fall asleep)is lengthened; the actual period of sleepis shortened

(3)Sleep Disturbances • Ovarian failure with consequent declining estradiol induces a change in a woman’s sleep cycle so that restful sleep becomes difficult and for some, impossible. The latent phase of sleep(I.e,the time required to fall asleep) is lengthened; the actual period of sleep is shortened

. Therefore,perimenopausal andpostmenopausal women complain ofhaving difficulty falling asleep and ofwaking up soon after going to sleep. Thisis one of the most disabling and leastappreciated adverse effects of menopause.The sleep cycle is restored to thepremenopausal state bytheadministration of replacement estrogens

• 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

(4)Vaginal Dryness and GenitalTractAtrophy The vaginal mucosa, cervix, endocervix.endometrium, myometrium, and uroepitheliumare estrogen-dependent tissues. With decreasingestrogen production, these tissues becomeatrophic, resulting in various symptoms. Thevaginal epithelium becomes thin and cervicalsecretions diminish

(4)Vaginal Dryness and Genital Tract Atrophy • The vaginal mucosa, cervix, endocervix, endometrium, myometrium, and uroepithelium are estrogen-dependent tissues. With decreasing estrogen production, these tissues become atrophic, resulting in various symptoms. The vaginal epithelium becomes thin and cervical secretions diminish