Natural menopause occurs when there is a complete, or near complete, ovarian follicular depletion of a female's ovaries. This results in the end of her menstrual cycle for 12 months, which is retrospectively determined. It occurs at a median age of 51.4 years and menopause before the age of 40 years old is considered abnormal. The months and years leading up to this are called peri-menopause.
|Vaginal dryness and/or Sexual function||
Stages of Reproductive Aging Workshop (STRAW) staging system was developed from data from multiple longitudinal cohort studies. This system is considered the gold standard and includes criteria for the reproductive years, the menopausal transition, perimenopause, final menstrual period (FMP), and postmenopause based upon bleeding patterns, endocrine findings, and symptoms. The STRAW system is used mainly in research, however, it may be helpful in the clinical setting for patients and clinicians to assess fertility potential, contraceptive needs, and potential need for hormone therapy.
|Late reproductive years||May begin to notice changes in her menstrual cycle (ie. a shorter cycle)|
|Early menopausal transition||This is marked by increased variability in menstrual cycle length|
|Late menopausal transition||Marked by the occurrence of amenorrhea of 60 days or longer
Characterized by increased variability in cycle length, and extreme fluctuations in hormonal levels
|Early postmenopause period||Corresponds to the end of “perimenopause,” a term still in common usage that means the time around menopause|
|Late postmenopause period||Symptoms of vaginal dryness and urogenital atrophy become increasingly prevalent at this time|
Longterm effects of menopause
It is important as part of the healthcare team, we are aware of the menopausal process and the symptoms that can come along with this period. Many of the symptoms and health concerns discussed can have a negative impact on a women's health and overall quality of life. It can be beneficial to be able to identify patients who are dealing with these symptoms because we can aid through physiotherapy interventions or refer them to a physician.
Sexual health may be negatively impacted by some of the issues stated above. Simple, non‐hormonal interventions for sexual dysfunction are often overlooked. Several studies show that education on vaginal lubricants, moisturizers, and dilator use (as needed) can have a positive impact on sexual health. Pelvic health physiotherapists are well positioned to assist patients with this.
Physiotherapists are able to assist in providing guidance around exercise in this population. Exercise, with a mix of cardio and resistance is beneficial in preventing fractures, maintaining bone mineral density, and body weight.
A systematic review encompassing only randomized controlled trails, conducted by Howe et al. (2011) examined the effectiveness of exercise interventions in preventing bone loss and fractures in postmenopausal women, and they found that exercise was safe and effective way to prevent bone loss in this population.
Additionally, higher levels of participation in physical activity were independently associated with lower weight, waist circumference, and risk of substantial weight gain.
Patients should discuss treatment options with their physicians. This may include menopause hormone therapy to aid with the issues listed above. Menopause hormone therapy can include estrogen and/or progestin.
- low dosage for the management of vaginal atrophy (also known as GSM)
- high dosage can be used to treat vasomotor symptoms (ie. hot flashes)
Bone mineral density
- Physicians or a Registered Dietician/Nutritionist can advise on diet, Vitamin D and Calcium
American College of Obstetricians and Gynecologists: Menopause Resource Overview
For further information on managing menopause, please refer to this presentation by Dr. Kathryn Macaulay
- The American College of Obstetricians and Gynecologists. Menopause: Resource Overview. Available from https://www.acog.org/Womens-Health/Menopause
- Burger HG. Unpredictable endocrinology of the menopause transition: clinical, diagnostic and management implications. Menopause international. 2011 Dec;17(4):153-4.
- Burger HG, Hale GE, Dennerstein L, Robertson DM. Cycle and hormone changes during perimenopause: the key role of ovarian function. Menopause. 2008 Jul 1;15(4):603-12.
- Thurston RC, Joffe H. Vasomotor symptoms and menopause: findings from the Study of Women's Health across the Nation. Obstetrics and Gynecology Clinics. 2011 Sep 1;38(3):489-501.
- Randolph JF, Sowers M, Bondarenko IV, Gold EB, Greendale GA. The relationship of longitudinal change in reproductive hormones and vasomotor symptoms across the menopausal transition. Fertility and Sterility. 2004 Sep 1;82:S65.
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