Menopause

Menopause is the physiological cessation of menstrual cycles associated with advancing age in species that experience such cycles. Menopause is sometimes referred to as change of life or climacteric.

Vaginal Canal Normal vs. Menopause

Menopause, often colloquially referred to as the "change of life" or "climacteric," signifies the physiological cessation of menstrual cycles, which is typically associated with advancing age in species that undergo such cycles. This biological transition is marked by significant changes in the reproductive system and a range of physical and psychological symptoms, stemming from the ovaries' gradual cessation of estrogen production.

Menopausal Transition

The process leading to menopause is often called the climacteric, although popular usage frequently substitutes this term with menopause. This process, which typically takes a year but can last from six months to over five years, involves increasingly sporadic and scanty menstrual periods.

While menopause is a natural and expected part of a woman's aging process, termed natural or physiological menopause, certain medical procedures, such as a hysterectomy including an oophorectomy (removal of the ovaries), can induce menopause.

Onset and Causes

The average onset of menopause is around 50.5 years. However, certain conditions like cancer, serious illness, chemotherapy, or specific genetic factors can trigger early menopause, known as premature menopause or premature ovarian failure, before the age of 40. This premature condition is seen in approximately one percent of women and is typically diagnosed by measuring the levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in the blood. A higher level of these hormones usually indicates the occurrence of menopause.

Health Risks

Post-menopausal women, particularly Caucasian women of European descent, are at an increased risk of osteoporosis due to the decrease in estrogen levels.

Animal Kingdom and Menopause

Menopause is rare in animals, possibly because many do not live long enough to experience it. However, some primates, like gorillas, have been observed to go through menopause, with an average onset age of 44.

Perimenopause

The term perimenopause refers to the period preceding menopause, when hormone production, such as estrogen and progesterone, begins to decrease and become irregular, leading to diminished fertility. It can begin as early as age 35 and last for several months or years. The exact duration cannot be predicted in advance.

Etiology

Menopause is primarily caused by the eventual atresia or degeneration of almost all oocytes (immature egg cells) in the ovaries. This leads to decreased production of estrogen, leading to menopause symptoms such as hot flashes, insomnia, osteoporosis, atherosclerosis, vaginal atrophy, and depression.

Certain lifestyle factors, such as cigarette smoking, can expedite the onset of menopause by approximately one year.

Symptoms

The clinical features of menopause, primarily caused by estrogen deficiency, span across various bodily systems and include:

• Vasomotor instability: Hot flashes, sleep disturbances
• Urogenital atrophy: This includes symptoms like dyspareunia (painful sexual intercourse), vaginal dryness, bleeding, urinary frequency and urgency, and incontinence.
• Skeletal changes: There can be an increased risk of osteoporosis, joint pain, muscle pain, and back pain.
• Skin and soft tissue: Menopause can lead to breast atrophy, skin thinning, and decreased elasticity.
• Psychological effects: These may include mood disturbances, irritability, fatigue, decreased libido, and memory loss.

Treatment of Symptoms

Several medical treatments have been developed to manage the symptoms of menopause. Most notably, Hormone Replacement Therapy (HRT) has been used to reduce the risk of osteoporosis, a condition characterized by weakened bones.

However, there has been resistance against viewing menopause as a disorder, with some arguing that it should be recognized as a natural stage of life. Additionally, there has been ongoing scientific debate over the cost-benefit balance of HRT. For several years, women were advised to undertake hormone therapy post-menopause to mitigate the risks of heart disease and various aspects of aging. However, the Women's Health Initiative, a large, randomized, controlled trial, found that women undergoing HRT experienced increased risks of Alzheimer's disease, breast cancer, heart disease, and stroke.

See Also

• Premature ovarian failure
• Hormone replacement therapy
• Osteoporosis
• Women's Health Initiative

Menopause Resources
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