Gynecological Pathology in the Menopause (Excluding Cancers)

John Eden
In: Managing the Menopause · 2020 · pp. 155–163 · doi:10.1017/9781108869102.017 · W4242039895
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This paper discusses gynecological pathologies in menopause excluding cancers, highlighting how fluctuating sex hormone levels and anovulation drive these conditions.

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This chapter from the book "Managing the Menopause" examines non-cancerous gynecological pathologies occurring during perimenopause and menopause, focusing on how fluctuating sex hormone levels contribute to these conditions. It highlights that irregular menstrual bleeding in women in their forties often results from anovulatory cycles with high estrogen peaks unopposed by progesterone, which drives various uterine disorders. The text references pathological mechanisms of adenomyosis alongside other common issues like fibroids and abnormal uterine bleeding to explain the clinical features observed in this demographic. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

The forties are a time of irregular and sometimes heavy menstrual loss due to fluctuating levels of sex hormones. Some months are characterized by low estrogen secretion and anovulation and others by extremely high levels of estradiol (E2). In a 20-year-old woman, E2 usually peaks at 500–1000 pmol/L. In contrast, some perimenopausal women may have cycles where E2 levels peak at around 5000 pmol/L. These high levels of estrogen are often not followed by ovulation and so progesterone is either not secreted at all, or levels are too low to counter these high-estrogen months. As we will see shortly, many gynecologic pathologies are driven by these unbalanced sex hormone levels.
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Temporary Disruption We have implemented additional assurance measures to protect our systems. As a result, we have suspended some of our systems and services. We apologise for any temporary disruption some customers may experience. - Managing the Menopause - Managing the Menopause - Copyright page - Contents - Contributors - Foreword - Chapter 1 Physiology of the Menstrual Cycle and Changes in the Perimenopause - Chapter 2 Clinical Features of the Menopause/Postmenopause - Chapter 3 The Ovarian Reserve - Chapter 4 Premature Ovarian Insufficiency - Chapter 5 Premature Ovarian Insufficiency - Chapter 6 Natural Hormone Replacement Therapy after Menopause by Ovarian Tissue Transplantation - Chapter 7 Migraine in the Menopause - Chapter 8 Psychological Aspects of the Menopause - Chapter 9 Memory and Mood in the Menopause - Chapter 10 Libido and Sexual Function in the Menopause - Chapter 11 Vulvo-Vaginal Atrophy (VVA) - Chapter 12 Pelvic Floor, Urinary Problems and the Menopause - Chapter 13 The Effect of Menopause on the Musculoskeletal System - Chapter 14 Hormonal Management of Osteoporosis during the Menopause - Chapter 15 Cardiovascular Disease and the Menopause - Chapter 16 Gynecological Pathology in the Menopause (Excluding Cancers) - Chapter 17 Nutrition and Weight Gain in the Menopause - Chapter 18 The Use of Estrogens and Progestogens in Menopausal Hormone Therapy - Chapter 19 Androgen Therapy for Postmenopausal Women - Cahpter 20 Contraception for the Perimenopausal Woman - Chapter 21 Hormone Therapy and Cancer - Chapter 22 Menopausal Hormone Therapy (MHT) and Venous Thrombosis - Chapter 23 The Risk–Benefit Analysis of Menopausal Hormone Therapy in the Menopause - Chapter 24 Selective Estrogen Receptor Modulators (SERMs) and Menopausal Hormone Therapy (MHT) - Chapter 25 Non-hormonal Treatments for Menopausal Symptoms - Chapter 26 Alternative Therapies for the Management of Menopausal Symptoms - Chapter 27 Menopause in Primary Care - Index - References Published online by Cambridge University Press: 18 June 2020 By Book contents - Managing the Menopause - Managing the Menopause - Copyright page - Contents - Contributors - Foreword - Chapter 1 Physiology of the Menstrual Cycle and Changes in the Perimenopause - Chapter 2 Clinical Features of the Menopause/Postmenopause - Chapter 3 The Ovarian Reserve - Chapter 4 Premature Ovarian Insufficiency - Chapter 5 Premature Ovarian Insufficiency - Chapter 6 Natural Hormone Replacement Therapy after Menopause by Ovarian Tissue Transplantation - Chapter 7 Migraine in the Menopause - Chapter 8 Psychological Aspects of the Menopause - Chapter 9 Memory and Mood in the Menopause - Chapter 10 Libido and Sexual Function in the Menopause - Chapter 11 Vulvo-Vaginal Atrophy (VVA) - Chapter 12 Pelvic Floor, Urinary Problems and the Menopause - Chapter 13 The Effect of Menopause on the Musculoskeletal System - Chapter 14 Hormonal Management of Osteoporosis during the Menopause - Chapter 15 Cardiovascular Disease and the Menopause - Chapter 16 Gynecological Pathology in the Menopause (Excluding Cancers) - Chapter 17 Nutrition and Weight Gain in the Menopause - Chapter 18 The Use of Estrogens and Progestogens in Menopausal Hormone Therapy - Chapter 19 Androgen Therapy for Postmenopausal Women - Cahpter 20 Contraception for the Perimenopausal Woman - Chapter 21 Hormone Therapy and Cancer - Chapter 22 Menopausal Hormone Therapy (MHT) and Venous Thrombosis - Chapter 23 The Risk–Benefit Analysis of Menopausal Hormone Therapy in the Menopause - Chapter 24 Selective Estrogen Receptor Modulators (SERMs) and Menopausal Hormone Therapy (MHT) - Chapter 25 Non-hormonal Treatments for Menopausal Symptoms - Chapter 26 Alternative Therapies for the Management of Menopausal Symptoms - Chapter 27 Menopause in Primary Care - Index - References The forties are a time of irregular and sometimes heavy menstrual loss due to fluctuating levels of sex hormones. Some months are characterized by low estrogen secretion and anovulation and others by extremely high levels of estradiol (E2). In a 20-year-old woman, E2 usually peaks at 500–1000 pmol/L. In contrast, some perimenopausal women may have cycles where E2 levels peak at around 5000 pmol/L. These high levels of estrogen are often not followed by ovulation and so progesterone is either not secreted at all, or levels are too low to counter these high-estrogen months. As we will see shortly, many gynecologic pathologies are driven by these unbalanced sex hormone levels. - Type - Chapter - Information - Managing the Menopause , pp. 155 - 163Publisher: Cambridge University PressPrint publication year: 2020 Bergeron, C, Amant, F, Ferenczy, A. Pathology and pathophysiology of adenomyosis. Best Prac Res Clin Obstet Gynaecol 2006;20:511–21.CrossRefGoogle ScholarPubMed McCluggage, WG. Ovarian borderline tumours: a review with emphasis on controversial areas. Diag Histopath 2011;17:178–91.Google Scholar Munro, MG, Critchley, HOD, Fraser, IS. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fert Ster 2011;95:2204–8.Google ScholarPubMed Briggs, P. The management of heavy menstrual bleeding associated with uterine fibroids using Ulipristal acetate, 5 mg daily (Esmya®, Preglem) followed by the introduction of a Levonorgestrel – Intrauterine System (LNG-IUS, Mirena®, Bayer). Giorn Ital Ostet Ginecol 2013;35:150–2.Google Scholar Martin, J, Bhanot, S. Complications and reinterventions in uterine artery embolization for symptomatic uterine fibroids: a literature review and meta-analysis. Cardiovasc Intervent Radiol 2013;36:395–402.CrossRefGoogle ScholarPubMed Heliövaara-Peippo, S, Hurskainen, R, Teperi, R, et al. Quality of life and costs of levonorgestrel-releasing intrauterine system or hysterectomy in the treatments of menorrhagia: a 10 year randomized controlled trial. Am J Obstet Gynecol 2013;209:535e1–e14.CrossRefGoogle ScholarPubMed Accessibility compliance for the HTML of this chapter is currently unknown and may be updated in the future. To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle. Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service. - Gynecological Pathology in the Menopause (Excluding Cancers) - - Book: Managing the Menopause - Online publication: 18 June 2020 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox. - Gynecological Pathology in the Menopause (Excluding Cancers) - - Book: Managing the Menopause - Online publication: 18 June 2020 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. 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