Lh Fsh Menopause

The menopause

The word climacteric is sometimes used to describe the 'change of life'. Menstruation generally ceases between the ages of 47 and 52. Sometimes

the menopause is delayed up to the age of 55 or even later; sometimes it occurs at 40 or even earlier. An early puberty tends to be followed by a late menopause, while a late onset of menstruation is often followed by an early cessation. The times of puberty and the menopause are to some extent a racial characteristic. In a few women the periods stop abruptly; more often the loss gradually diminishes, or a period now and then is missed until they finally cease. Anovular cycles are more frequent as the menopause approaches. Fertility is therefore diminished, and pregnancy is exceedingly rare after the age of 50.

At the time of the menopause few Graafian follicles can be found in the ovaries, which shrink in size. The ovarian production of oestrogen ceases and the pituitary gland, liberated from negative feeback (see p. 28), produces gonadotrophic hormones in excess. In some women oestrogens are still found, probably from the suprarenal cortex or by conversion of androgens in fat tissues.

After the menopause there is gradual atrophy of the genital organs. The uterus diminishes in size, and the endometrium becomes thin and atrophic. The vaginal wall becomes thin and smooth with a fall in the acidity of the secretion, and the fornices become shallow around a small cervix. The labia are flatter and the growth of pubic hair is diminished. The ligaments and fascia which support the uterus atrophy, and prolapse may become evident if there has been previous damage during childbirth. Atrophic endometritis, atrophic vaginitis and atrophic changes in the vulva may occur.

Climacteric symptoms While the menopause may occur without any symptoms other than the cessation of menstruation, it is not infrequently associated with other symptoms, of which the commonest is the occurrence of hot flushes. There is flushing of the face and neck, often with sweating. The flushes are very variable in duration and frequency; they may only be momentary, or they may last for up to 15 minutes and recur many times a day. When they are severe they cause discomfort and embarrassment. During a flush there is a rise in peripheral blood flow (as measured in the arm) and a rise in pulse rate, but no change in blood pressure.

The cause of flushes is uncertain. There is a fall in the level of circulating oestrogens, and a temporary rise in the level of gonadotrophins, both FSH and LH. It was found that flushes are checked by administering oestrogens or testosterone. Because of these facts it was suggested that flushes were caused by the rise in gonadotrophin levels. However, women with and without flushes have similar gonadotrophin levels, and in cases in which oestrogens control the flushes the gonadotrophin levels do not fall. Moreover, flushes do not occur when gonadotrophins are given to ~induce ovulation, and they have been reported in women after hypophy-

sectomy. All these facts have thrown doubt on the theory that flushes are caused by gonadotrophins.

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khurram akhtar

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