Menopause

This article is about the condition affecting women. For the condition called male menopause, see Andropause. For the medical journal, see Menopause (journal).
Not to be confused with mesopause.

Menopause
Other namesClimacteric
SpecialtyGynecology
SymptomsNo menstrual periods for a year[1]
Duration~3 years
CausesUsually a natural change.
Can also be caused by surgery that removes both ovaries, and some types of chemotherapy.[2][3]
TreatmentNone, lifestyle changes[4]
MedicationMenopausal hormone therapy, clonidine, gabapentin, selective serotonin reuptake inhibitors[4][5]

Menopause, also known as the climacteric, is the time when menstrual periods permanently stop, marking the end of reproduction.[1][6][7] It typically occurs between the ages of 45 and 55, although the exact timing can vary.[8] Menopause is usually a natural change related to a decrease in circulating blood estrogen levels.[3] It can occur earlier in those who smoke tobacco.[2][9] Other causes include surgery that removes both ovaries, some types of chemotherapy, or anything that leads to a decrease in hormone levels.[10][2] At the physiological level, menopause happens because of a decrease in the ovaries' production of the hormones estrogen and progesterone.[1] While typically not needed, a diagnosis of menopause can be confirmed by measuring hormone levels in the blood or urine.[11] Menopause is the opposite of menarche, the time when a girl's periods start.[12]

In the years before menopause, a woman's periods typically become irregular,[13][14] which means that periods may be longer or shorter in duration or be lighter or heavier in the amount of flow.[13] During this time, women often experience hot flashes; these typically last from 30 seconds to ten minutes and may be associated with shivering, night sweats, and reddening of the skin.[13] Hot flashes[13] can recur for four to five years.[6] Other symptoms may include vaginal dryness,[15] trouble sleeping, and mood changes.[13][16] The severity of symptoms varies between women.[6] Menopause before the age of 45 years is considered to be "early menopause" and when ovarian failure/surgical removal of the ovaries occurs before the age of 40 years this is termed "premature ovarian insufficiency".[17]

In addition to symptoms (hot flushes/flashes, night sweats, mood changes, arthralgia and vaginal dryness), the physical consequences of menopause include bone loss, increased central abdominal fat, and adverse changes in a woman's cholesterol profile and vascular function.[17] These changes predispose postmenopausal women to increased risks of osteoporosis and bone fracture, and of cardio-metabolic disease (diabetes and cardiovascular disease).[17]

Medical professionals often define menopause as having occurred when a woman has not had any menstrual bleeding for a year.[2] It may also be defined by a decrease in hormone production by the ovaries.[18] In those who have had surgery to remove their uterus but still have functioning ovaries, menopause is not considered to have yet occurred.[17] Following the removal of the uterus, symptoms of menopause typically occur earlier.[19] Iatrogenic menopause occurs when both ovaries are surgically removed along with uterus for medical reasons.

The primary indications for treatment of menopause are symptoms and prevention of bone loss.[20] Mild symptoms may be improved with treatment. With respect to hot flashes, avoiding smoking, caffeine, and alcohol is often recommended; sleeping naked in a cool room and using a fan may help. The most effective treatment for menopausal symptoms is menopausal hormone therapy (MHT).[15][20] Non-hormonal therapies for hot flashes include cognitive-behavioral therapy, clinical hypnosis, gabapentin, fezolinetant or selective serotonin reuptake inhibitors.[21][22] These will not improve symptoms such as joint pain or vaginal dryness which affect over 55% of women.[20] Exercise may help with sleeping problems. Many of the concerns about the use of MHT raised by older studies are no longer considered barriers to MHT in healthy women.[20] High-quality evidence for the effectiveness of alternative medicine has not been found.[6]

  1. ^ a b c "Menopause". Office on Women's Health. 22 February 2021. Retrieved 20 October 2022.
  2. ^ a b c d "Menopause Basics". Office on Women's Health. 22 February 2021. Retrieved 20 October 2022.
  3. ^ a b "Menopause Baics". Office on Women's Health. 22 February 2021. Retrieved 20 October 2022.
  4. ^ a b "What are the treatments for other symptoms of menopause?". Eunice Kennedy Shriver National Institute of Child Health and Human Development. 28 June 2013. Archived from the original on 20 March 2015. Retrieved 8 March 2015.
  5. ^ Krause MS, Nakajima ST (March 2015). "Hormonal and nonhormonal treatment of vasomotor symptoms". Obstetrics and Gynecology Clinics of North America. 42 (1): 163–179. doi:10.1016/j.ogc.2014.09.008. PMID 25681847.
  6. ^ a b c d Menopause: Overview. Institute for Quality & Efficiency in Health Care. 2 July 2020. Retrieved 20 October 2022 – via National Library of Medicine - Bookshelf.
  7. ^ Angelou K, Grigoriadis T, Diakosavvas M, Zacharakis D, Athanasiou S (8 April 2020). "The Genitourinary Syndrome of Menopause: An Overview of the Recent Data". Cureus. 12 (4): e7586. doi:10.7759/cureus.7586. ISSN 2168-8184. PMC 7212735. PMID 32399320.
  8. ^ Takahashi TA, Johnson KM (May 2015). "Menopause". The Medical Clinics of North America. 99 (3): 521–534. doi:10.1016/j.mcna.2015.01.006. PMID 25841598.
  9. ^ Warren M, Soares CN, eds. (2009). The menopausal transition: interface between gynecology and psychiatry ([Online-Ausg.] ed.). Basel: Karger. p. 73. ISBN 978-3805591010.
  10. ^ "Menopause & Chemotherapy - Managing Side Effects - Chemocare". chemocare.com. Archived from the original on 21 November 2012. Retrieved 20 October 2022.
  11. ^ "How do health care providers diagnose menopause?". Eunice Kennedy Shriver National Institute of Child Health and Human Development. 6 May 2013. Archived from the original on 2 April 2015. Retrieved 8 March 2015.
  12. ^ Wood J. "9". Dynamics of Human Reproduction: Biology, Biometry, Demography. Transaction Publishers. p. 401. ISBN 9780202365701. Archived from the original on 10 September 2017.
  13. ^ a b c d e "Menopause Symptoms and Relief". Office on Women's Health. 22 February 2021. Retrieved 20 October 2022.
  14. ^ "What Is Menopause?". National Institute on Aging. 30 September 2021. Retrieved 20 October 2022.
  15. ^ a b Mark JK, Samsudin S, Looi I, Yuen KH (3 May 2024). "Vaginal dryness: a review of current understanding and management strategies". Climacteric. 27 (3): 236–244. doi:10.1080/13697137.2024.2306892. ISSN 1369-7137. PMID 38318859.
  16. ^ Marino JM (November 2021). "Genitourinary Syndrome of Menopause". Journal of Midwifery & Women's Health. 66 (6): 729–739. doi:10.1111/jmwh.13277. ISSN 1526-9523. PMID 34464022.
  17. ^ a b c d Davis SR, Lambrinoudaki I, Lumsden M, Mishra GD, Pal L, Rees M, et al. (April 2015). "Menopause". Nature Reviews. Disease Primers. 1 (1): 15004. doi:10.1038/nrdp.2015.4. PMID 27188659.
  18. ^ Sievert LL (2006). Menopause: a biocultural perspective ([Online-Ausg.] ed.). New Brunswick, N.J.: Rutgers University Press. p. 81. ISBN 9780813538563. Archived from the original on 10 September 2017.
  19. ^ International position paper on women's health and menopause : a comprehensive approach. DIANE Publishing. 2002. p. 36. ISBN 9781428905214. Archived from the original on 10 September 2017.
  20. ^ a b c d Davis SR, Baber RJ (August 2022). "Treating menopause - MHT and beyond". Nature Reviews. Endocrinology. 18 (8): 490–502. doi:10.1038/s41574-022-00685-4. PMID 35624141. S2CID 249069157.
  21. ^ "The 2023 nonhormone therapy position statement of The North American Menopause Society". Menopause. 30 (6): 573–590. 21 June 2023. doi:10.1097/GME.0000000000002200. ISSN 1072-3714. PMID 37252752. S2CID 258969337.
  22. ^ Krause MS, Nakajima ST (March 2015). "Hormonal and nonhormonal treatment of vasomotor symptoms". Obstetrics and Gynecology Clinics of North America. 42 (1): 163–179. doi:10.1016/j.ogc.2014.09.008. PMID 25681847.