Menopause
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Definition[edit | edit source]
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.[1]
Clinical Exam[edit | edit source]
Subjective:
Symptoms of menopause and peri-menopause are:[2][3]
| Symptoms | Information |
|---|---|
| Hot flashes |
|
| Vaginal dryness | |
| Sexual function | |
| Mood symptoms | |
| Sleep disturbances | |
| Joint pain | |
| Cognitive changes | |
| Irregular bleeding or spotting |
Longterm consequences of low estrogen:
| Health Concerns | Information |
|---|---|
| Bone loss | |
| Cardiovascular disease | |
| Dementia | |
| Osteoarthritis | |
| Body composition | |
| Skin changes | |
| Balance |
Objective:
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.[6]
| Stage[6] | Signs/Symptoms[6] |
|---|---|
| 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 |
Management[edit | edit source]
Resources[edit | edit source]
American College of Obstetricians and Gynecologists: Menopause Resource Overview
References[edit | edit source]
- ↑ 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.
- ↑ Gold, E.B., Colvin, A., Avis, N., Bromberger, J., Greendale, G.A., Powell, L., Sternfeld, B. and Matthews, K., 2006. Longitudinal analysis of the association between vasomotor symptoms and race/ethnicity across the menopausal transition: study of women’s health across the nation. American journal of public health, 96(7), pp.1226-1235.
- ↑ 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.
- ↑ 6.0 6.1 6.2 Harlow S, Gass M, Hall J, Lobo R, Maki P, Rebar R, Sherman S, Sluss P, de Villiers T. Executive summary of the stages of reproductive aging workshop+ 10. Menopause. 2012 Apr 1;19(4):387-95.
