Hormone Replacement Therapy After The Menopause

Abstract

Menopause occurs at a median age of 51 years, the age of menopause appears to be determined genetically and does not seem to be related to race, nutritional status, age of menarche however it may occur earlier in cigarette smokers, in some women who have had hysterectomies and in nulliparous women.

Although menopause is a natural event, the years inunediately before and the decades afterwards are of much greater clinical significance, it can be uneventful or a time of significant symptoms.

The main mechanism underlying the menopause is the depletion of the store of primordial follicles. However, other mechanisms could be involved, namely loss of follicular responsiveness to the pituitary gonadotropins, this is supported by the presence of residual, dormant primordial follicles in post-menopausal ovaries and a significant increase in serum follicular stimulating hormone (FSH) concentration with distinct concomitant decrease in estrodial E2 level. In some women, ovarian function is lost earlier and more suddenly than expected as a result of natural causes, chemotherapy & radiotherapy, and surgery resulting in premature menopause.

The key endoctinologic event of the menopause is the decrease in ovarian production of estrogen followed by secondary increase in gonadotropin secretion and some relative alternation in androgen activity.