Assignment on Premature Menopause
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Assignment 2 – Research Proposal, 2018Student name: Student ID: TitleSTUDY OF PREMATURE MENOPAUSE AMONG URBAN WOMEN AGED 30 TO 45YEARS IN GREAT WESTERN SYDNEY REGION, AUSTRALIAResearch problemEarly or premature menopause among women has been of major concern. The causes,contributory factors, symptoms and treatment have not been well understood by mostpremenopausal women who would otherwise bear children at that age (Moen, M, 2010).The motivation in this premenopausal women study is to bridge the gap of knowledge onwhat causes premature menopause, symptoms, social factors and how it can be preventedor treated. This will go a long way to help planners and policy makers to have substantialinformation about premature menopause. What is already knownPremature menopause is a condition whereby women below 40 years stop receivingmenstrual periods and hence lose fertility. Onset of premature menopause is presented with
amenorrhea, rise in gonadotrophic levels and oestrogen deficiency. Menopause can happenin two ways it can be natural or induced that is through chemotherapy or surgicaloophorectomy (Faddy, M, 2016).According to Okeke, et al, premature menopausal is a condition that affects about 1% ofwomen below 40 years. It presents itself in primary and secondary amenorrhea wherebyprimary amenorrhea takes about 10-28% and secondary amenorrhea takes 4-18 %. Thisshows that primary amenorrhea takes a large percentage of premature menopause due toproblems in development. Development problems occur when there is ovarian failure,uterine absence and puberty delays. Secondary amenorrhea occurs due to disturbances inhormone and formation of a scar inside the uterine. Although causes of prematuremenopause have not been established but what causes the condition can be established. Thearticle gives causes including: genetic disorders, smoking, autoimmune diseases,infections, iatrogenic, surgery, drugs and pathophysiology. Genetic disorders causepremature menopause through dysgenesis of the ovary and sex chromosomesabnormalities. Dysgenesis of the ovary accounts to 30% of all cases, this is because that iswhere the actual menstrual cycle happens. Alteration in chromosomes due to abnormalitiesaccounts for 10-20% of all cases whereby X sex chromosomes is involved (Okeke, T,2013). The article by Okeke highlights the common chromosomal abnormalities that maymark onset of premature menopause including: pure gonadal dysgenesis , TurnersSyndrome, familial and trisomy 13 and trisomy 18. Cases whereby there is geneticalteration of metabolism factors to cause 17 alpha-hydroxylase deficiencies, galactosaemiaand myotonic dystrophy can contribute to the condition. Genetics can also cause alterationto the immune system as to cause mucocutaneous fungal infections, Ataxia telangiectasia
and Di George syndrome this can also contribute to the condition (Okeke, T, 2013).Autoimmune diseases account 30-60% of cases which present itself through thyroiddiseases, mumps, hyperparathyroidism, adrenal insufficiency and Addison’s diseases. Thisshows follicle infiltration with plasma cells and lymphocytes as seen through ovarianbiopsy. Infections like mumps have contributed to premature menopause; mumps presentsitself best during fetal and pubertal periods this can lead to failure of the ovary.3% of somepremature menstruation cases is caused by pelvic tuberculosis this leads to synechiae of theintrauterine and endometrium destruction. Smoking cases premature menopause throughpolycyclic hydrocarbon contained in cigarette smoke. Radiation can also cause prematuremenopause through radiations and chemotherapy. Irradiation of megavoltage of about4500-5000 radiations cause failure in the ovary and also lose dose radiation throughdomestic microwave appliances. Chemotherapeutic agents like alkylating agents,actimomycin, methotrexate, 6 mercaptopurine and Adriamycin can induce ovarian organfailure. Surgery can also cause premature menopause this is though bilateral oophorectomyto prevent ovarian cancer and also hysterectomy interferes with ovarian blood supply andfunctional endocrine contribution between uterus and ovary. Surgery alone accounts for15-50% of cases. In some aspect of premature menopause cases of ovarian suppression andfailure can be seen especially by drugs like alkylating agents. Clinical features that hasidentified premature menopause include: vaginal dryness and dyspareunia, urinary tractone can feel frequency, urgency, incontinence and atrophic cystitis. Other symptoms thatmark premature menopause comprise: headache, cancer phobia, anxiety, hot flushes,irritability, night sweats, depression, irritability, skin atrophy, joint pains and inability toconcentrate (Okeke, T, 2013).
According to Australian menopause society, information sheet, they look at earlymenopause from perspectives of premature and unexpected ovarian failure. The result ofovarian failure leads to a number of consequences. When the ovary stops to work in thebody they stop producing eggs and producing secondary female hormones namelyoestrogen and progesterone. This leads to loss of bearing capacity in many women. Failureto produce hormones leads to stop of menstrual periods (Maclennan, A 2017). Thedeficient oestrogen cause hot flushes, mood change due to hormonal imbalance,disturbances when someone is sleeping, lead to stops of production of vaginal fluidsresulting to dry vagina. Cases whereby a woman has had premature menopause emotionalturmoil may set in. This is clearly seen whereby a woman feeling sad, jealous otherwomen’s pregnancies. The article proceeds to give the long-term consequences ofpremature menopause which are osteoporosis which speeds up the arteries hardening. Thehardening of arteries may predispose someone to heart attack or stroke.According to guideline of the Europe society of human reproduction and embryology theygive a clear outline on how to manage women with premature ovarian insufficiency. Thisspells out good news on how to manage premature menopause. The article gives someinterventions that can be done case of loss of fertility this include: oocyte donation is oneof the best fertility interventions (Luborsky, J, 2013). Cases whereby there is bone loss,women are advised to take a balanced diet to ensure sufficient intake of calcium andvitamin D. The article cites oestrogen replacement to prevent osteoporosis and this helpmaintain bones. Additionally, women may consider taking a combined oral contraceptive ifdeemed appropriate. The article proceeds to tackle the issue of cardiovascular health inpremature ovarian insufficiency, it deals through hormone replacement therapy which
should be started early to prevent a future risk of getting cardiovascular disease. Thisshould be done constantly until a woman reaches natural menopause age. Cases wherebythe woman has Turner Syndrome, the person should be assessed on their blood pressure,smoking, weight, lipid profile, fasting plasma glucose and HbA1c.The article provides alsointervention such as psychological and lifestyle support to improve their quality of life. Thearticle tackles the issue of sexual and genito-urinary function in the following ways: it citesadequate oestrogen replacement for making sexual function normal. This helps treatdyspareunia. Counseling should be given to women with premature ovarian insufficiencyon the need of supplementing testerone for long term efficacy and safety. On the issue ofgenito-urinary, there should administration of hormone replacement therapy through localestrogens. Additionally, lubricants can be used to treat vaginal dryness and dyspareunia forwomen who are not using hormone replacement therapy. On the issue of inducing pubertyto premature ovarian therapy, women should take transdermal estradiol to induce puberty(Luborsky, J, 2013).The international journal of obstetrics and gynecology carried out a study using a sample of4868 women to determine the cognitive and dementia in premature menopause womenlater in life. The study was done in a timeline of two, four and seven years. The studyfound out there is no notable association between dementia risk and premature menopause.The study further gave some future consequences of premature ovarian failure which wereaffects verbal fluency of women, poor performance which were not different on normalmenopausal women (Woad, K, 2016). This study adds to existing knowledge on influenceof premature menopause on cognitive function of the body.Monika Satpathy in her article studies the age at menopause, menopausal problems and
symptoms among urban women from western odishia, India. This tables looks at mean ageat which menopause occurs:Studies in India Year studiedRegion studied Mean age atmenopausePresent study2014Urban women ofWestern Odisha44.82Bansal et al2010Women fromPunjab rural45.9Borker et al2013Urban women48.26Madhukumar&Gaikwad2012Women ofBangalore rural49.7Sarker et al2014Urban women fromJamnagar45.3Sharma et al2007Urban women fromjammu47.53Singh & Ahuja1980Women of Assam40.32Sengupta1993Karbarta(Assam)42.95Kulkarni & Joshi1979Deshastha BraminMaharashtra43.46Kar & Mahanta1975Singhpho women43.65Balgir1985Sikligar Women,Punjabi43.71Sharma & Sing1980Chondary WomenKangra43.84Sing &Ahuja1980Arora WomenPunjabi43.96Gosh & Kumari1973Sindhi womenDelhi44.60Singh & Ahuja1980Punjahi women44.68Singh & Arora2005Woman from ruralnorth India44.1
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