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Surgical menopause

The ovaries produce estrogen, progesterone and androgens to regulate the menstrual cycle. When a hysterectomy occurs, these hormones get suddenly interrupted and their levels fall resulting in symptoms of menopause. This is termed surgical menopause. Although removal of ovaries becomes unavoidable in most hysterectomy surgeries, every effort is made by the surgeon to leave the ovaries intact in order to avoid the sudden absence of hormones. Most often, surgical menopause is caused quite dramatically when there is surgical interference like hysterectomy, bilateral oophorectomy, where both the ovaries are removed. A woman undergoing surgical menopause experiences certain symptoms more profoundly than women going through menopause normally. Since there is abrupt disruption of hormones after hysterectomy, the menopausal symptoms are more severe, more frequent and last longer when compared to natural menopause. The symptoms are triggered by the body's sudden inability to make certain hormones due to the removal of ovaries.


Estrogen is immediately given after surgery to try to prevent the intense changes especially the hot flashes that can occur in woman undergoing hysterectomy. However the use of estrogen is itself controversial and it is not usually recommended for women with existing or high risk of cardiovascular disease. A lowest dose of estrogen for the shortest possible time is recommended.

Surgical menopause risks

  • Women with surgical menopause are seven times more prone to cardiovascular disease risks.

  • They run the risk of osteoporosis as estrogen plays a vital role in bone formation.

  • Gum tissues are affected and regular dental check ups are advised to tide over this problem.

  • Women younger than 45 years and who have had their ovaries removed face a mortality risk 170% higher than women who have retained their ovaries after oophorectomy. Hormone replacement therapy is commonly advised as it is believed by many doctors to mitigate the mortality risks.

  • There is a definite lowering of sexual desire in women who have undergone surgical menopause. This reduction is greater than that seen in women undergoing natural menopause.

Polycystic Ovarian Syndrome

In PCOS, under-developed follicles accumulate in the ovaries. Since they fail to mature, they accumulate as cysts in the ovaries. The low levels of follicle stimulating hormone (FSH) and elevated levels of androgens may be the reasons for this condition. When there is no ovulation, the progesterone hormone is not created and the lining of the uterus is not shed in a timely fashion. This increases the chances of endometrial hyperplasia and even cancer.


Another feature associated with PCOS is hyper androgenism or increased responsiveness to testosterone. This usually shows up in oily skin and acne. Excess hair may be noticed on the face and other parts of the body. Women suffering from PCOS have a weight problem, especially around the waist. Insulin resistance is also noticed in some women. This increases the risk of developing diabetes in later years.


Polycystic Ovarian Syndrome Symptom


  • Absence of menses or abnormal or scanty menstrual periods
  • Weight gain
  • Infertility
  • Aggravated acne
  • Increased hair growth in a male pattern

High levels of insulin can result in symptoms such as high androgen levels, infertility and lack of ovulation. These symptoms are usually noticed when women are in their 20s or 30s. Diagnosis of PCOS is after a physical examination and laboratory tests. Thyroid and prolactin levels in the blood are tested. Serum levels of male hormones (DHEA and testosterone) are tested for higher than normal levels. Tumors in the ovary or adrenal glands can be diagnosed with vaginal and abdominal ultrasounds. Insulin resistance is vital in the diagnosis of PCOS. Insulin is instrumental in regulating the ovarian function. An ovarian biopsy may also be done.


Treatment for Polycystic Ovarian Syndrome

Treatment for women with Polycystic Ovarian Syndrome depends on what stage of a woman's life this condition has manifested and her fertility desires. Birth control pills are prescribed to regularize the menstrual cycle and reduce the risk of uterine cancer. Other medications used in the treatment of PCOS are flutamide and spironolactone.

Clomiphene induces the pituitary gland to secrete more FSH and this stimulates release and maturity of ova. Insulin resistance is reduced with drugs such as Metformin (Glucophage) and Troglitazone. 'Ovarian drilling' is a process of using laser to place small holes in the ovaries so as to normalize the hormonal environment and allow normal ovulation.


LH

Luteinizing Hormone LH is another important hormone for reproduction. In men, LH promotes secretion of testosterone. In women, LH surge in the second part of the menstrual cycle triggers ovulation. LH is released when a woman is ovulating, and causes the ovaries to release an egg. LH and FSH are closely linked. At the beginning of the menstrual cycle, FSH and LH are secreted to stimulate ovarian follicles. Mid-cycle, the growing follicle will inhibit FSH secretion and increase estrogen. This is a trigger for sudden release of LH that leads to release of the mature egg.


The LH Surge is vital for pregnancy - as it causes the matured egg to be released. The next 24 - 36 hours are the fertile window when a woman can get pregnant. Ovulation Predictor Kits that are available measure LH level in the urine - identifying the best time to conceive. Reduced levels of LH in females indicate ovarian hyperfunction.

LH and PCOS

In females suffering from PCOS - Polycystic Ovarian Syndrome, the LH levels are already elevated when compared to FSH. Since there is no LH surge, ovulation does not take place. Elevated LH levels cause release of androgens from the ovaries leading to acne and Hirsutism. Infertility and miscarriage are common. Studies have shown that there is a direct relation between insulin resistance and elevated LH levels.


LH levels

In females, the LH levels in the blood can vary based on stage of menstrual cycle, age, pregnancy and other pituitary gland disorders. It can be measured by a blood test or urine test. Usually this test is prescribed for women with irregular periods trying to get pregnant or assessing if a woman has entered menopause. Men with low testosterone levels or having very late puberty are asked to take the LH test.

High levels of Luteinizing hormone are most often caused by ovarian tumors or improperly-developed ovaries. Thyroid or Adrenal disease can elevate LH levels. PCOS and Autoimmune disorders also cause the levels of Luteinizing hormone to rise. Low levels of Luteinizing hormone indicate ovarian failure or primary testicular failure. This can happen due to viral infections such as mumps, autoimmune disorders, radiation exposure and tumors.


Women:

Early phase of menstrual cycle: 0.5 to 16.9 IU/L

Peak of menstrual cycle: 8.7 to 76.3 IU/L

Using contraceptives: 0.7 to 5.6 IU/L

Pregnant: less than 1.5 IU/L

Menopause: 15.9 to 54.0 IU/L

Men:

Between 20 years and 70 years: 0.7 to 7.9 IU/L

Over 70 years: 3.1 to 34.0 IU/L


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Bibliography / Reference

Collection of Pages - Last revised Date: November 22, 2019