MENOPAUSE

MENOPAUSE

Definisi
WHO menopause adalah berhentinya
menstruasi secara permanen akibat tidak
bekerjanya folikel ovarium.
Masa klimakterik selama 30 tahun (usia 35-65
tahun), dibagi menjadi 3 bagian untuk
kepentingan klinis, yaitu: klimakterik awal (35-
45 tahun), perimenopause (46-55 tahun) dan
klimakterik akhir (56-65 tahun).
 Mulai menurun ,rendah dan sangat rendah estradiol

35 KLIMAKTERIUM 65
35 45 56 65
Klimak. awal Klimak. akhir
46 Perimenopause
50 55

Gangguan haid - Vasomotor - Gangguan otak

Hipermenorea - Konstitusional Alzheimer
Hipomenorea - Psikiastenik - Arterosklerosis
PUD neurotik - Gangguan jantung
- Vaginal - Osteoporosis
tract urin - Ancaman Ca colon
osteopenia (limbic emosi
osteoporosis hipokarpus-memori)
- Perubahan genital,
HIPOTHALAMUS GnRH
PULSASI BATAS KRITIS

PITUITARI
GONADOTROPIN
HUB. UMPAN BALIK BAKU
(FSH & LH)
- Kadar Hormon Reproduksi Tiap Saat
- IRAMA

STEROIDOGENESIS OVARIUM - FOLIKULOGENESIS

&
- OOGENESIS
UTERUS
(ENDOMETRIUM)

HAID OVULASI
 AMENORE / OLIGOMENORE
TDK ADA
TSH & PRL HAMIL, KELAINAN BAWAAN
TEST PROGEST HIRSUTISME, GALAKTORE
TUNGGU
2-7 HARI
PERDARAHAN (+) PERDARAHAN (-)

E + P SEQUENTIAL
ANOVULASI
DISFS.OVULASI
PERDARAHAN (+) PERDARAHAN (-)
2 MINGGU
PX.GONADOTROPIN KEL.UTERUS

RENDAH NORMAL TINGGI

FOTO SELLA / Tes GnRH / Tes CC 2 MG BILA
KERUSAKAN (-) KERUSAKAN (+) HAID (-)
KEGAGALAN
HIPOTALAMUS PITUITARI
OVARIUM
 MENOPAUSE

AMENORE ANOVULASI KESUBURAN /

Cadangan Sel Telur /

Kualitas Sel Telur
Kepekaan Ov. Thd Gonadotrophin

FUNGSI OVARIUM /
 OVARIUM FETUS TUA

JUMLAH SEL 6 - 7 JUTA 1 - 2 JUTA 300 RIBU HABIS

TELUR
1. JUMLAH OOGONIA TERTENTU
HAMIL 20 MG SAAT LAHIR PUBERTAS MENOPAUSE
2. PERTUMBUHAN FOL SAMPAI PRE
MASA
KEHIDUPAN
ANTRAL TIDAK TERGANTUNG FSH WANITA

3. MENOPAUSE : OOGONIA HABIS

HUB UMPAN LH
BALIK &
FSH
JML SEL DHA
TELUR ANDROSTENEDION
ESTRADIOL
 AMENORE KARENA
KEGAGALAN OVARIUM
 MENOPAUSE
KEGAGALAN OVARIUM

STEROIDOGENESIS OOGENESIS FOLIKULOGENESIS

/

- AMENORE OVULASI

- E2
 MENOPAUSE
HAID
> 1 Tahun

UMUR Fungsi Ovarium - Kelainan Bawaan

(Penuaan) / - Didapat

Degenerasi

Steroidogenesis Folikulogenesis

Atrofi Epitel
S.S.P E2 Ovulasi
Osteoporosis
C.V.D

HAID FSH Fertilitas /

Amenore
PERUBAHAN APAKAH DIBALIK
MENOPAUSE ?

Atrofi Epitel
S.S.P
Osteoporosis
C.V.D
 KADAR SERUM E2 - MACAM KELUHAN

Barbieri (1992)
Cegah Osteoporossis
E Threshold Hypothesis

< 60 pg / ml Atrofi Epith. Serum E2

Vagina 30 50 pg /ml

Serum E2 < 40 pg / ml Semburan Panas

Therapeutic
< 20 pg / ml Osteoporosis Window

* Riszk Botros and Abdalla Hossam, Endometriosis Fast Facts Indespensable Guides to Clinical Prtice, Ed Iind . Health Press,
Oxford 2003
ATROFI EPITEL GENITAL

MENOPAUSE
( 60 TH SEKS AKTIF )

40 %

NYERI
SANGGAMA
ATROFI EPITEL PENUTUP ( UROGENITAL )

DISPAREUNIA
VAGINITIS
ESTROGEN
INKONTINENSIA
URINE

REKTOKEL PENUAAN
SISTOKEL
 EFFECT OF ESTROGEN ON BRAIN FUNCTION
Organizational Actions Effects on neurotransmitters
Effects on neuronal number, morphology, and Acetylcholine
connection occuring during critical stages of Noradrenaline
development Serotonin
Dopamine
Neurotropic Actions
Glutamine
Neuronal differentiation
Gamma Aminobutyric Acid
Neurite extension
Neuropeptides
Synapse Formation
Effects on Glial Cells
Interactions with neurotrophins
Neuroprotective Actions Effects on protein involved in
Protection against apoptosis Alzheimers Disease
Antioxidant properties Amyloid precursor protein
Antiinflamatory properties Tau protein
Augementation of Cerebral Blood Flow Apolipoprotein E
Enhancement of Glucose transport into the brain
Blunting of Cortiosteroid response to behavioral
stress
Interactions
Gargiulo with
Antonio R (2004) neurotrophins
: Reproductive Immunology and Its Disorders.
In Yen and Jaffes Reproductive Endocrinology. Ed V Th Elsevier Saunders. Philadelphia. P : 421- 452
 PERAN ESTROGEN TULANG

* ABSORBSI KALSIUM ( 1.25 - DIHIDROXYVITAMIN D )

* PERAN LANGSUNG KETULANG

( RESEPTOR ESTROGEN DI OSTEOBLAST )

- MENGATUR PROD. CYTOKINE ( IL 1 & 6 )

- MENGATUR IG F I & II, TRASFORMING GROWTH FACTOR

- RESEPTOR VIT D DI OSTEOBLAST

( MENGATUR AKTIVITAS 1.25 - DIHIDROXYVITAMIN D DI TULANG )

 MODEL FOR MEDICATION OF EFFECTS OF ESTROGEN (E) ON OSTEOCLAST
FORMATION AND FUNCTION BY CYTOKINES IN BONE MARROW MICROENVIRONMENT
Monocytes T Cells

Stimulatory Factors

IL 1 Inhibitory Factors
TNF TNF TNF

E E
E
Active OC OC Apoptosis
OC Precursors Differentation
and Activation

E OPG

E E
IL - 6 M-CSF RANKL RANKL TGF TGF
PGE2 E
GM-CSF
E
Stromal Cells /
Osteoblasts
Gargiulo Antonio R (2004) : Reproductive Immunology and Its Disorders.
In Yen and Jaffes Reproductive Endocrinology. Ed V Th Elsevier Saunders. Philadelphia. P : 421 - 452
KELAINAN KARDIOVASKULER
WANITA MUDA PASCA MENOPAUSE

- HDL - HDL - KOLESTROL

( 10 MG / DL > PRIA ) TOTAL

- LDL - LDL - LP ( a )

PASCA MENOPAUSE
PENYAKIT PEMBULUH DARAH KORONER 2X
 DAMPAK E
PADA JANTUNG WANITA
I. DAMPAK PADA PEMB. DARAH KORONER
- ANGIOGENESIS
- HAMBAT ATHEROGENESIS
- VASORELAKSASI
- MODULASI ENDOTHEL TIGHT JUNCTION

II. DAMPAK PADA OTOT JANTUNG

- METABOLISME
- KONTRAKTILITAS
- FREKUENSI OTOT ( RATE )
 MENOPAUSE AND CARDIOVASCULAR RISK

MENOPAUSE INDUCTED
PARAMETER HRT INDUCED CHANGES
CHANGES
Lipid and Lipoprotein Metabolism TC , HDL-C, LDL-C TC , HDL-C, LDL-C
Lp (a) Lp (a)

Homocysteine Metabolism Homocysteine Homocysteine

Hemostatics Factors Fibrinogen , Factor VII , Fibrinogen , Factor VII ,

PAI 1 , t-PA PAI 1 , t-PA

Glucose Metabolism Insulin Sensitivity Insulin Sensitivity

Insulin Elimination Insulin Elimination
Insulin Secretion Insulin Secretion

Peripheral Vascular resistance Increased Decreased

Endothelium Dependent Vasomotion Endothelin -1 Endothelin -1

NO NO

Endothelium Independent Vasomotion Ca-influx in vascular smooth muscle Ca-influx in vascular smooth muscle

V. Mijatovic. Postmenopausal Hormone Replacement and Cardiovascular Risk Markers Lipoprotein (a)
and Homocysteine, Ponsen & Looijen Wageningen
Amsterdam, 1999. P : 11 - 16