How does the depletion of gonadal hormone during menopausal transition (MT) affect reproductive organs?

Updated: Jun 06, 2018
  • Author: PonJola Coney, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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The effects of gonadal hormone depletion can be obvious on pelvic examination, with changes noted before menopause in some women. The reproductive organs of a woman who is of reproductive age greatly differ in appearance from the organs of a woman who is menopausal. With loss of estrogen, the vaginal epithelium becomes redder as the epithelial layer thins and the small capillaries below the surface become more visible. Later, as the vaginal epithelium further atrophies, the surface becomes pale because of a reduced number of capillaries.

A decrease in urine pH leading to a change in bacterial flora may result in pruritus and a malodorous discharge. Rugation also diminishes, and the vaginal wall becomes smooth. Such changes often result in insertional dyspareunia and, for many women, eventually lead to sexual abstinence if left untreated.

Inside the pelvis, the uterus becomes smaller. Fibroids, if present, become less symptomatic, sometimes shrinking to the point where they can no longer be palpated on manual pelvic examination. Endometriosis and adenomyosis are also alleviated with the onset of menopause, and many patients with pelvic pain finally achieve permanent pain relief.

The menopausal ovary diminishes in size and is no longer palpable during gynecologic examination. A palpable ovary on pelvic examination warrants a full evaluation in all women who are menopausal or postmenopausal.

For older women, a general loss of pelvic muscle tone also occurs, sometimes manifested as prolapse of reproductive or urinary tract organs (see Uterine Prolapse and Pelvic Organ Prolapse). Vaginal pressure, lower back pressure, or bulging at the vaginal introitus is common in women with prolapse. On examination, cystocele, rectocele, and uterine prolapse are obvious as causes of these symptoms.

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