Menopause

Menopause is the cessation of a woman's reproductive ability, the opposite of menarche. Menopause is usually a natural change; it typically occurs in women in midlife, during their late 40s or early 50s, signalling the end of the fertile phase of a woman's life.

Menopause is commonly defined by the state of the uterus and the absence of menstrual flow or "periods", but it can instead be more accurately defined as the permanent cessation of the primary functions of the ovaries.[2] What ceases is the ripening and release of ova and the release of hormones that cause both the build-up of the uterine lining, and the subsequent shedding of the uterine lining (the menses or period).

Signs and effects

During the menopause transition years, as the body responds to the rapidly fluctuating and dropping levels of the body's own hormones, a number of effects may appear. Not every woman experiences bothersome levels of these effects; the degree to which they occur varies greatly from person to person.

General

Hot flashes (aka hot flushes), also including night sweats, and, rarely, cold flashes. Technically known as vasomotor instability, i.e. the inability to regulate body temperature properly.

Possible but contentious increased risk of atherosclerosis :

• Migraine
• Rapid heartbeat
• Dysfunctional bleeding

Urogenital atrophy Also known as vaginal atrophy

Thinning of the membranes of the vulva, the vagina, the cervix, and also the outer urinary tract, along with considerable shrinking and loss in elasticity of all of the outer and inner genital areas.

• Itching
• Dryness
• Watery discharge
• Urinary frequency

Urinary incontinence may worsen the menopause-related quality of life, although urinary incontinence is more related to obstetric events than to menopause.

• Urinary urgency

Increased susceptibility to inflammation and infection, for example vaginal candidiasis, and urinary tract infections.

In India the median age of natural menopause is considerably earlier, at 44 years.

Youngest. In rare cases, a woman's ovaries stop working at a very early age, ranging anywhere from the age of puberty to age 40, and this is known aspremature ovarian failure (POF). Spontaneous premature ovarian failure affects 1% of women by age 40, and 0.1% of women by age 30.

The menopause transition, and postmenopause itself, is a natural life change, not a disease state or a disorder.

Essential Change

For example, when the uterus is surgically removed (hysterectomy) in a younger woman, her periods will cease permanently, and she will be incapable of pregnancy, but as long as at least one of her ovaries is intact and still functioning, the woman will not have reached menopause; ovulation will continue until menopause is reached. In contrast, when a woman's ovaries are removed (oophorectomy), even if the uterus is intact, the woman will immediately experience a menopause which is both sudden and total; this is known as surgical menopause.

Premenopause

Premenopause is a term used to mean the years leading up to the last period, when the levels of reproductive hormones are already becoming more variable and lower, and the effects of hormone withdrawal are present.[25] Premenopause often starts some time before the monthly cycles become noticeably erratic in timing.

Perimenopause

The term "perimenopause", which literally means "around the menopause", refers to the menopause transition years, a span of time both before and after the date of the final episode of flow.

Management

Perimenopause is a natural stage of life. It is not a disease or a disorder, and therefore it does not automatically require any kind of medical treatment. However, in those cases where the physical, mental, and emotional effects of perimenopause are strong enough that they significantly disrupt the everyday life of the woman experiencing them, palliative medical therapy may sometimes be appropriate.

Hormone replacement therapy (HRT)

In the context of the menopause, hormone replacement therapy (HRT) is the use of estrogen, plus progestin in women who have an intact uterus and estrogen alone in those without a uterus.[41]

HRT may be reasonable for the treatment of menopausal symptoms such as hot flashes.[42] Its use appears to increase the risk of strokes and blood clots.[43] When used for menopausal symptoms it should be used for the shortest time possible and at the lowest dose possible.[43] The response to HRT in each postmenopausal women may not be the same. Genetic polymorphism in estrogen receptors appears to be associated with inter-individual variability in metabolic response to HRT in postmenopausal women.[44]

It also appears effective for preventing bone loss and osteoporotic fracture.

• Selective estrogen receptor modulators
• Antidepressants
• Alternative medicine
• Phytoestrogens
• Soy isoflavones
• Other therapies

Lack of lubrication is a common problem during and after perimenopause. Vaginal moisturizers can help women with overall dryness.

Low-dose prescription vaginal estrogen products such as estrogen creams are generally a safe way to use estrogen topically, to help vaginal thinning and dryness problems (see vaginal atrophy) while only minimally increasing the levels of estrogen in the bloodstream.

In terms of managing hot flashes, lifestyle measures such as drinking cold liquids, staying in cool rooms, using fans, removing excess clothing, and avoiding hot flash triggers such as hot drinks, spicy foods, etc., may partially supplement (or even obviate) the use of medications for some women.

Individual counseling or support groups can sometimes be helpful to handle sad, depressed, anxious or confused feelings women may be having as they pass through what can be for some a very challenging transition time.

Osteoporosis can be minimized by smoking cessation, adequate vitamin D intake and regular weight-bearing exercise. The bisphosphate drug alendronate may decrease the risk of a fracture, in women that have both bone loss and a previous fracture and less so for those with just osteoporosis.