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- Natural menopause: defined retrospectively after 12 consecutive months of amenorrhea in a nonpregnant woman ≥40 years of age; mean age of 51 years
- Results from loss of ovarian activity
- Not associated with a pathologic etiology
- Perimenopause/menopausal transition (MT): the period from the onset of irregular menses to the final menstrual cycle. Begins on average 4 years before menopause; starts at mean age of 47 years
- Postmenopause: usually >1/3 of a woman’s life
- Primary ovarian insufficiency: irregular or cessation of menses before age 40 years
- Surgical menopause: removal of functioning ovaries leading to immediate menopause
- The median age of menopause is 51 years.
- 5% of women undergo menopause after age 55 years; another 5% between ages 40 and 45 years
- Occurs earlier in Hispanic women and later in Japanese American women as compared with Caucasians
In the United States, 1.3 million women reach menopause annually.
Etiology and Pathophysiology
- As women age, the number of ovarian follicles decreases: Ovarian production of estrogen varies and then decreases. Follicle-stimulating hormone (FSH) production varies and then increases.
- Inadequate estradiol production leads to absence of the luteinizing hormone (LH) surge and failure to ovulate. These cycles result in anovulation and lack of progesterone production.
- Eventual failure to produce estradiol leads to thinning of endometrial lining and eventual menses cessation.
- Estrone (produced by adipose tissue) becomes the dominant form of estrogen during menopause.
- Sex chromosome abnormalities (e.g., Turner syndrome and fragile X syndrome)
- Family history of early menopause
- Smoking (earlier age of onset by 2 years)
- Chemotherapy and/or pelvic radiation
Menopause is a physiologic event and associated with increased risk of long-term medical issues, including cardiovascular disease (CVD) and osteoporotic fractures.
- Decrease risk of CVD by:
- Increasing exercise
- Maintaining healthy diet and losing weight
- Avoiding tobacco use
- Treating hypertension, hyperlipidemia, and diabetes mellitus
- Taking daily low-dose aspirin
- Decrease risk of osteoporotic fractures with:
- Weight-bearing exercise and fall prevention
- Avoidance of smoking and excessive alcohol intake
- Dietary calcium of 1,200 mg/day
- Adequate vitamin D intake (800 to 1,200 IU daily)
- Fall prevention