Geriatrics: Changes in Women

The menopause in which the cycle of ovulation ceases is one of the most widely studied age-related changes in biology. Menopause generally occurs between the ages of 45 and 52 years. The ovaries are the female reproductive glands which secrete estrogen and produce the reproductive cells (ova). They are located on each side of the uterus in the pelvis. At menopause the production of estrogen decreases by about 95% and there is a rapid decline in oocytes. With menopause the ovaries become fibrotic and atrophy.

The lower estrogen levels also causes atrophic changes in the uterus and vagina. The uterine lining thins and the elasticity decreases. Vaginal secretions are reduced. Most of the signs and symptoms of menopause are the result of a 95% decrease in the levels of circulating estrogen. Common symptoms include hot flashes, palpitations, irritability, headaches, depression, fatigue, weight gain, insomnia, night sweats, forgetfulness, and inability to concentrate. The vaginal walls become thinner and less elastic and there is a decrease in lubrication. Many of these symptoms can be avoided through estrogen replacement therapy (ERT).

In the years following menopause the circulating follicle stimulating hormone (FSH) and luteinizing hormones (LH) are greatly increased. Over subsequent years, FSH and LH levels fall slowly before leveling off about 30 years after menopause. These hormonal changes cause a relaxation of ligaments and a loss of muscular tone that alter the contour of the breast.

Women who are not on ERT face an increased risk for osteoporosis, heart attack, stroke and possibly Alzheimer's Disease.