Menopause

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Basics

Description

  • 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

Epidemiology

  • 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

Incidence
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.

Risk Factors

  • Aging
  • Oophorectomy/hysterectomy
  • 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

General Prevention

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

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