A 55-year-old woman is seen by her physician and is told that she is currently g

Question

A 55-year-old woman is seen by her physician and is told that she is currently going through menopause when he identifies that she has an elevation of FSH on her laboratory results. The patient has many questions and concerns, and the physician asks the nurse to provide education for the patient.

1. The patient first asks the nurse why the elevation of FSH is important. In answering the question for the patient, use the concept of negative feedback.

2. The patient states she has had hot flashes, vaginal dryness, and increased emotional lability. Describe why the patient would have these clinical manifestations during menopause.

Explanation / Answer

1. Follicle stimulating hormone (FSH) is responsible for maintaining proper reproductive system in body along with luteinizing hormone (LH). The secretion of these hormones from pituitary is activated by action of gonadotrophin releasing hormone (GnRH) on gonadotrophs. When GnRH stimulates secretion of FSH and LH, secretion of estrogen and progesterone is stimulates respectively. FSH stimulates ovarian follicle growth and maturation in ovaries. When secretion of estrogen is increased, a negative feedback decreases the release of FSH. Gonad also secretes inhibin which inhibits the secretion of FSH.

During perimenopausal period there is decease in level of inhibin which results in increased secretion of FSH due to absence of negative feedback. This elevated level of FSH is the marker of menopause.

2. Hormonal changes in body especially decrease in estrogen are responsible for these symptoms. Estrogen directly affects the reproductive organs, activity of serotonin and noradrenaline. The disturbance in neurotransmitter and hormonal activity result in these symptoms.

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