2. *menarche (puberty)
*menstrual cycle
*menopause and HRT
*climacterium praecox,
climacterium tardum,
iatrogenic menopause.
*senium

3. Hormones:
1) Estrogens - estradiol (12-80x more
potent)
- estrone
- estriol
2) Progestin - progesterone
-17-hydroxyprogesterone
3) Androgens - testosterone

4. menarche (puberty)
• sequence of biochemical and
physiologic events (adrenarche
and gonadarche)
result in the growth spurt of adolescence,
development of secondary sex
characteristics, and reproductive capacity

5. • Adrenarche: ↑ secretion of
androgens by the adrenal gland,
(age 5 – 20)
• Gonadarche: the initiation of
production of significant
amount of sex steroids

6. Age at menarche, (n = 397)
•

8. Natural menopause
*end of reproductive life
*the permanent cessation of
menstruation
*loss of ovarian follicular activity
*no pathological cause

9. Dx menopause :
1) No menses > 12 mths
2) 17β-estradiol levels < 74 pmol/L
3) FSH levels > 30 IU/L
(Nik Nasri Ismail, ‘Menopause and HRT
in Malaysia’ in First Consensus
Meeting on Menopause in the East
Asian Region)

10. Age and menopausal status :

11. Perimenopause
• immediately prior to the
menopause and the first year
after menopause.

12. Climacteric
-incorporates the perimenopause
(a longer variable period before
and after the perimenopause).
-“climacteric syndrome.”

13. senium
• Phase of life started from 65 –
70 years upwards
• FSH and LH levels drop again
(age-related involution of the
pituitary gland).

14. Statistics
• Mean age for menopause is 50.7
years (Seng CK, 1986).
• Women’s life expectancy : 68 yrs in
1985 to 74 yrs in 1993 (Arshat H et
al., 1989).
☞ 1/3 life, in a hypoestrogenic
state.

15. Endocrinology of
menopause
Less negative feedback,
↑FSH, ↑LH
Hypothalamo-pituitary tact
↓ovarian follicular
estrogen
↓ circulating estrogen
(estrone) to target tissues

16. Endocrinology of
menopause
• adrenal androgen (by ovarian
stromal)
• in response to elevated LH
levels
• Androgen : estrogen ratio (facial
hair, male pattern baldness)

17. Pituitary gonadotropins
FSH - follicle stimulating hormone
LH - luteinizing hormone
PRL - prolactin

18. FSH - follicle stimulating
hormone
In Females,
• responsible for the early
growth of ovarian follicles
In Males,
• helps mantain the
spermatogenic epithelium
by stimulating Sertoli cells

19. LH - luteinizing hormone
In Females,
• final maturation of the ovarian
follicles and their estrogen
secretion, for ovulation, the
initial formation of the corpus
luteum and secretion of
progesterone
In Males,
• stimulation of testosterone
production from Leydig cells of
testis

21. Action of Estrogen :

23. Common Clinical
Symptoms
• Vasomotor flushes (hot flushes)
- 95% ☞ within three months,
(85% : symptom > one year)
- sudden sensation of intense
warmth accompanied by a
visible ascending flush of the
thorax, neck, and face, followed
by profuse sweating.

24. • Osteoporosis
-Estrogens,
☺inhibit osteoclast function
☺increase intestinal Ca2+absorption
-Peak bone mass age 30,
with 0.2% loss/year after age 40,
becomes 4%/year at menopause
-bone fragility and fracture

25. • Urogenital atrophy
- atrophic urethritis and cystitis
- Vulva and vagina : ↓ mucuos
production, thin epithelium

26. • Cardiovascular disease
- ↑↑ CHD in postmenopausal ≈ men at
the age 70 (B.Ettinger et al.,1996 and
S.A Samaan et al.,1995) by influencing:
1) lipoprotein level
2) direct action on arterial wall
- Abnormal coagulation system

28. Circulation index (hot flushes, sweats,
palpitations, dizziness) and
Nervosity index (irritability, headache,
depression, insomnia) :

31. Increased Risk factors for
Menopause:
• Environmental influences may
alter the ovarian aging process.
• Smoking and high coffee intake
advances the age of menopause
by about 2 years (Kaufmann DW
et al,1980).
• Familial and genetic factors
• Ovarian surgery, adhesions, and
pelvic endometriosis

32. Selection of patients for HRT:
• 1. Pap smear for those with uterus
• 2. Fasting lipid profile
• 3. Mammography
• 4. Fasting blood sugar
• 5. Others if indicated — endometrial biopsy,
FSH, LH, ultrasound

33. HRT or NO HRT???

34. Controversial :
• Important studies :
1) The Heart and
Estrogen/Progestin
Replacement Study (HERS)
2) Women’s Health initiative
study (WHI)(JAMA, 2002)