Menopause&hormone Replacement Therapy

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menopause

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absence of menses >12months

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absence of menses in women of reproductive age=

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amenorrhea not same as menopause

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termination of ovulation means termination of

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menstrual cycle

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menopause preceded by

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perimenopause: up to six years before menopause, irregular cycles

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at birth female hase 3-7millian follciles, at puberty 1/10-1/30 of original amount, at menopause

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<.1%, LH/FSH fail to induce growth of follicle

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in menopause since no follicle growth-->

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-no estrogen to inhibit LH/FSH
-FSH/LH high
-estrogen/progesterone low levels
-no follicle development,dominance or ovulation
-mens. stops,cycle stop

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2 types of oral contraceptives

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-combined (estrogen +progestogens)
-progestogen only

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combined oral contraceptive explain

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-progestogen negative feedback on hypo-->inhibit GnRH--> reduce LH/FSH
-estrogens exert negative feedback on ant pit-->decrease LH
-no LH/FSH=no follicle development/dominance/ovulation
-endometrium still develops, when stop pill/switch placebo after day 21=menses occur

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3 types of progestogen only

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very low dose: not stop ovulation,thickens cervical mucus=prevent sperm penetration
medium dose: inhibit ovulation (97-99%) via neg feedback, thickens cervical mucus
-high dose: completely inhibit follicular development, thicken mucus
-effect on menses depend if taken 21 or 28 days

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mean age of menoupause__-if before 45 called

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51,premature menopause

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younger age of menopause linked with (3)
late menopause higher risk of (2)

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-cardiovascular disease, osteoporosis, overall morality
-breast/endometrial cancer

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hormone replacement therapy increases

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breast cancer death risk

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estrogen receptors in CNS can be found in hippo mainly in ___region also in__region of___

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CA1,CA3,dendate gyrus

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estrogen is steroid hormone so it can

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diffuse across membrane-->bind receptor-->DNA binding transcription factor-->regulate gene expression

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estrogen effect in CNS could act (3)

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-directly on hippo pyramidal cells
-on connection between hippo regions
-on support cells surrounding neuronal cells (like astrocyte a glial cell)

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estrogen and link to NMDA receptor

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estrogen cause increase in binding to NMDA receptor in hippo

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activate NMDA receptor via glutamate=
blocking NMDA receptor=

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-new excitatory synapses to develop
-prevent estrogen induced synaptogenesis (affect learning)

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since estrogen receptors also present in interneurons, explain estrogen and relationship with GABA interneurons

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-estrogen suppress GABA (disinhibition) of CA1 neurons-->upregulation NMDA receptors and synapse formation

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hippo found

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-medial temporal lobe bilaterally

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estrogen has affect on cognition explain activational effect between mid luteal phase (estrogen HIGH) vs women in menstrual

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-when estrogen high-->perform better on verbal fluency,speeded articulation,manual speed or coordination tests

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women+estrogen replacement therapy have better

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verbal learning/memory

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in experiment to see strogen and affect on learning strategy, train female rat on t maze. showed that

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-high hormone level=more likely to select place over response strategy
-low hormone= select response over place strategy
-suggest-->estrogen have role in influencing learning strategy used, effect quality of memory stored

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probability that person use spatial strategy is higher if

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hippo integrity high

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voxel based morphometry

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-look at density of brain with fluctuating hormone levels
-technique show that taxi drivers have higher brain matter density in hippo
-can compare subjects based on how much gray matter in voxel (volumetric element)-->catch is brains are different

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study showed differences in brain density and looked at women in different stage of menstrual cycle
-did PMDD show different effect than control
-but when looking at women in late follicular phase (post-menstrual ie high estrogen) saw
-" "late luteal phase (premenstrual estrogen low)

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-no
-higher right anterior hippo density ie synaptogensis occurred
-lower right anterior hippo density
above shown via VBN
-also showed performance in verbal memory task suggest that change in grey matter density contribute to cognitive effect seen

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across menstrual cycle can see hippo volume variation

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true