1 Alumnos Nataly D. Mostacero Montalvo Jenny A. Narcizo Susaníbar Américo Peña Oscuvilca Jhonatan B. Quiñones Silva Alden Radas Barbié Docente Dr. Jorge Delgado Olano

2 DEFINICIONES Williams Gynecology 2008.

3 CAMBIOS EN EL EJE HIPOTALÁMICO HIPOFISARIO FSH Atresia de folículos ováricos Episodios anovulatorios Insuficiencia ovárica Inhibina Williams Gynecology 2008.

4 MENOPAUSIA Rev Per Ginecol Obstet. 2008;54: 69-70. Atresia folicular o agotamiento folicular termina la etapa reproductiva de la mujer Niveles de estradiol son muy bajos gran aumento de la FSH

5 Rev Per Ginecol Obstet. 2008;54: 69-70. Cardiovascular

6 Genitourinario Rev Per Ginecol Obstet. 2008;54: 69-70.

7 Osteomuscular Rev Per Ginecol Obstet. 2008;54: 69-70.

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9 Quiñones-Silva JB

10 Síntomas Síntomas de la transición menopáusica Cambios en el patrón menstrual Ciclos más cortos o largos Sangrado irregular (hipermenorrea, oligomenorrea, manchas) Disfunción sexual Sequedad vaginal Libido disminuido Dispareunia Síntomas vasomotores Enrojecimiento y calentura Sudoraciones nocturnas Disturbios del sueño Síntomas somáticos Dolor de cabeza Mareos Palpitaciones Dolor de pecho Dolor de articulaciones y de espalda Alteraciones emocionales Depresión Irritabilidad Cambios del humor Pérdida de la concentración Pobre memoria Otros síntomas Incontinencia urinaria Piel seca Ganancia de peso Copyright © 2008 by The McGraw-Hill Companies, Inc. All rights reserved. ISBN 978-0- 07-147257-9.

11 Physiologic changes (means) during a hot flush. A. Core body temperature. B. Respiratory exchange ratio. C. Skin temperature. Síntomas vasomotores

12 Respuesta termoreguladora Diagram of the interactions between sex steroid hormones and serotonin in the central nervous system (CNS) and their effects on thermoregulatory response. Serotonin (5-HT) receptors are those for the neurotransmitter serotonin A. Estrogen stabilizes the CNS thermoregulatory set point and leads to a normal response. B. During menopausal transition, decreased estrogen levels lead to instability of the set point and an altered response to external thermal stimuli. C. Gradually over time, the set point becomes stable again. Alternatively, pharmacologic intervention with exogenous estrogen or selective serotonin reuptake inhibitors (SSRIs) may also stabilize the set point

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15 Prolapse of the anterior vaginal wall. (Courtesy of Dr. Marlene Corton.)

17 Transvaginal sonographic images of a pre- and postmenopausal ovary. A. In general, premenopausal ovaries have greater volume and contain follicles, which are seen as multiple, small, anechoic smooth-walled cysts. B. In comparison, postmenopausal ovaries have smaller volume and are characteristically devoid of follicular structures. Copyright © 2008 by The McGraw-Hill Companies, Inc. All rights reserved. ISBN 978-0- 07-147257-9.

18 Microscopic differences between a reproductive-age and menopausal ovary. A. Reproductive- age ovary. Note preponderance of primordial follicles. B. High-power image of primordial follicles. C. The menopausal ovary shows abundance of atretic follicles and persistent corpora albicans. Copyright © 2008 by The McGraw-Hill Companies, Inc. All rights reserved. ISBN 978-0- 07-147257-9.

19 Diagnóstico diferencial de los síntomas de la menstruación Síntomas vasomotores Hipertiroidismo Feocromocitoma Enfermedad febril Ansiedad y síntomas psicológicos Osteoporosis primaria Osteomalacia Hiperparatiroidismo primario o secundario Sequedad vaginal Vaginosis bacteriana Infección micótica Patología pélvica Pobre lubricación vaginal Anovulación Cáncer endometrial Cáncer cervical Hiperplasia endometrial Pólipos endometriales Leiomioma uterino Atrofia urogenital Tratamiento hormonal Diagnóstico diferencial

20 Índice de maduración estrogénica Photomicrographs of cytologic specimens illustrate key points of the maturation index. This index provides insight into the cytohormonal status of the patient and is based on a count of parabasal, intermediate, and superficial (P:I:S) cells. Generally, a predominance of superficial or superficial and intermediate cells (A and B) is seen in reproductive-aged women. A predominance of intermediate cells (C) is seen in the luteal phase, pregnancy, with amenorrea, and in newborns, premenarchal girls, and women in early menopausal transition. A predominance of parabasal cells (D) is seen in menopausal patients with atrophy.

21 Índice de maduración estrogénica Photomicrographs of cytologic specimens illustrate key points of the maturation index. This index provides insight into the cytohormonal status of the patient and is based on a count of parabasal, intermediate, and superficial (P:I:S) cells. Generally, a predominance of superficial or superficial and intermediate cells (A and B) is seen in reproductive-aged women. A predominance of intermediate cells (C) is seen in the luteal phase, pregnancy, with amenorrea, and in newborns, premenarchal girls, and women in early menopausal transition. A predominance of parabasal cells (D) is seen in menopausal patients with atrophy.

22 Índice de maduración estrogénica Photomicrographs of cytologic specimens illustrate key points of the maturation index. This index provides insight into the cytohormonal status of the patient and is based on a count of parabasal, intermediate, and superficial (P:I:S) cells. Generally, a predominance of superficial or superficial and intermediate cells (A and B) is seen in reproductive-aged women. A predominance of intermediate cells (C) is seen in the luteal phase, pregnancy, with amenorrea, and in newborns, premenarchal girls, and women in early menopausal transition. A predominance of parabasal cells (D) is seen in menopausal patients with atrophy.

23 Índice de maduración estrogénica Photomicrographs of cytologic specimens illustrate key points of the maturation index. This index provides insight into the cytohormonal status of the patient and is based on a count of parabasal, intermediate, and superficial (P:I:S) cells. Generally, a predominance of superficial or superficial and intermediate cells (A and B) is seen in reproductive-aged women. A predominance of intermediate cells (C) is seen in the luteal phase, pregnancy, with amenorrea, and in newborns, premenarchal girls, and women in early menopausal transition. A predominance of parabasal cells (D) is seen in menopausal patients with atrophy.