1 / 79

Mood Killers: Hormones, Menopause, and Erectile Dysfunction

Mood Killers: Hormones, Menopause, and Erectile Dysfunction. Stacy Higgins, MD, FACP Emory University School of Medicine. Menopause. Definition. The permanent cessation of menses because of loss of ovarian follicular function A natural biologic process, not a disease!.

thad
Télécharger la présentation

Mood Killers: Hormones, Menopause, and Erectile Dysfunction

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Mood Killers: Hormones, Menopause, and Erectile Dysfunction Stacy Higgins, MD, FACP Emory University School of Medicine

  2. Menopause

  3. Definition • The permanent cessation of menses because of loss of ovarian follicular function • A natural biologic process, not a disease!

  4. Normal Menstrual Cycle

  5. Why does it happen? • Aging of the female reproductive system starts at birth • Steady loss of eggs from either ovulation or atresia • Once last egg is depleted- menopause

  6. Why so much attention? • Menopause affects every woman • Aging of the population means more women are postmenopausal than ever before • More postmenopausal women living beyond 65

  7. Terminology • Pre-menopause • Peri-menopause • Post-menopause • Premature menopause • Premature ovarian failure • Induced menopause

  8. Age at Menopause • Average age: 51.4 • (40-58) • Peri-menopause:47.5 • Lasts on average 4 years • No change in average age

  9. When will it happen? • Later than average: • Multiparous • Increased BMI • Earlier than average: • Nulliparous • Medically treated depression • Seizure disorder • Smoking

  10. Signs and Symptoms

  11. Hormonal • Irregular menses • Decreased fertility • Osteoporosis

  12. Vasomotor • Hot Flashes • Night Sweats • Sleep Disturbances

  13. Urogenital Atrophy • Itching • Dryness • Bleeding • Urinary frequency and urgency • Urinary Incontinence

  14. Skin Changes • Breast Atrophy • Skin Thinning • Decreased Elasticity • Thinning Hair

  15. Psychological • Mood disturbance • Irritability • Fatigue • Memory loss • Depression

  16. Sexual • Decreased Libido • Vaginal Dryness • Problems reaching orgasm • Dyspareunia

  17. Diagnosis • Usually clinical diagnosis • FSH • Home Testing • What else might it be? • Pregnancy!! • Thyroid problems

  18. Complications • Cardiovascular Disease • Osteoporosis • Urinary Incontinence • Weight Gain

  19. Self-Care

  20. Self-Care • Cool hot flashes • Decrease vaginal discomforts • Optimize your sleep • Strengthen your pelvic muscles • Eat well • Don’t smoke • Exercise regularly • Get regular checkups

  21. Medical Symptom Management • Estrogen • Low-dose Antidepressants • Clonidine • Complementary Medicines

  22. Systemic Estrogen • Most effective treatment option for relieving menopausal hot flashes • Take lowest dose needed to provide symptom relief • Weigh risk vs. benefit • Protects against osteoporosis • Increased risk of breast cancer, heart disease, stroke, and blood clots

  23. Antidepressants • Venlafaxine (Effexor)- selective serotonin reuptake inhibitor (SSRIs) • Shown to decrease menopausal hot flashes • Other helpful SSRIs- fluoxetine (Prozac/Sarafem), paroxetine (Paxil), citalopram (Celexa) and sertraline (Zoloft)

  24. Clonidine • Available as a pill or patch • Typically used to treat high blood pressure • May significantly reduce the frequency of hot flashes • Unpleasant side effects are common

  25. Vaginal Estrogen • Relieves vaginal dryness • Can be administered using a vaginal tablet, ring or cream • Releases just a small amount of estrogen, which is absorbed by the vaginal tissue • Also helps relieve discomfort with intercourse and some urinary symptoms

  26. Phytoestrogens • Two main types of phytoestrogens • Isoflavones: found in soybeans, chickpeas and other legumes • Lignans:occur in flaxseed, whole grains and some fruits and vegetables • Most studies have found them ineffective • Isoflavones have some weak estrogen-like effects

  27. Black Cohosh • Used to treat hot flashes, night sweats, vaginal dryness, and other symptoms • Study results are mixed on whether black cohosh effectively relieves menopausal symptoms • Studies to date have been less than 6 months long, so long-term safety data are not currently available • Can cause headaches and stomach discomfort

  28. Erectile Dysfunction

  29. Erectile Dysfunction • Inability to attain or maintain erection sufficiently firm to permit satisfactory sexual performance • Impotence is a broad term including problems of libido, erection and orgasm

  30. How common is it? • Prevalence of 5% in men <40 years • Prevalence of 55-75% in men 75-80 years • Approximately 600,000 new cases of ED each year

  31. Types of Dysfunction • Ability to obtain a full erection at some times (e.g. when asleep) • Obtaining erections which are either not rigid or full or lost rapidly

  32. Physiology • Penis innervated by nerves • Blood vessels bring blood to the penis • Brain provides stimulation

  33. How Does an Erection Happen? • Stimulation causes the brain to release chemicals • Chemicals bring message to nerves in the penis • Nerves tell penile blood vessels to relax • Blood flows into the penis • Pressure traps the blood, sustaining an erection

  34. Causes • Physiologic • Impedence of blood entering and being retained in the penis • Psychologic • Erection or penetration fails due to thoughts or feelings rather than physical impossibility

  35. Risk Factors • Vascular Disease is most common • Atherosclerosis • Diabetes • Hypertension • Cigarette smoking • Hypercholesterolemia

  36. Risk Factors • Age • More time or more physical stimulation to achieve erection • More control over ejaculation, but flow is reduced • Tend not to be as hard, and the refractory period is prolonged • More likely to take medication that contributes to erectile dysfunction

  37. Risk Factors • Medications • Antihypertensives (B-blockers, ACEI, Ca ch blockers, diuretics) • Antidepressants (TCAs, SSRIs) • Antipsychotics • Anticonvulsants • H2 receptor blockers • Statins and fibrates

  38. Risk Factors • Endocrine Abnormalities • Hypogonadotropic hypogonadism • Hyperthyroidism • Hypothyroidism • Hyperprolactinemia

More Related