Menopause | |
---|---|
Other names | Climacteric |
Specialty | Gynecology |
Symptoms | No menstrual periods for a year[1] |
Duration | ~3 years |
Causes | Usually a natural change. Can also be caused by surgery that removes both ovaries, and some types of chemotherapy.[2][3] |
Treatment | None, lifestyle changes[4] |
Medication | Menopausal hormone therapy, clonidine, gabapentin, selective serotonin reuptake inhibitors[4][5] |
Menopause, also known as the climacteric, is the time when menstrual periods permanently stop, marking the end of reproduction.[1][6][7] It typically occurs between the ages of 45 and 55, although the exact timing can vary.[8] Menopause is usually a natural change related to a decrease in circulating blood estrogen levels.[3] It can occur earlier in those who smoke tobacco.[2][9] Other causes include surgery that removes both ovaries, some types of chemotherapy, or anything that leads to a decrease in hormone levels.[10][2] At the physiological level, menopause happens because of a decrease in the ovaries' production of the hormones estrogen and progesterone.[1] While typically not needed, a diagnosis of menopause can be confirmed by measuring hormone levels in the blood or urine.[11] Menopause is the opposite of menarche, the time when a girl's periods start.[12]
In the years before menopause, a woman's periods typically become irregular,[13][14] which means that periods may be longer or shorter in duration or be lighter or heavier in the amount of flow.[13] During this time, women often experience hot flashes; these typically last from 30 seconds to ten minutes and may be associated with shivering, night sweats, and reddening of the skin.[13] Hot flashes[13] can recur for four to five years.[6] Other symptoms may include vaginal dryness,[15] trouble sleeping, and mood changes.[13][16] The severity of symptoms varies between women.[6] Menopause before the age of 45 years is considered to be "early menopause" and when ovarian failure/surgical removal of the ovaries occurs before the age of 40 years this is termed "premature ovarian insufficiency".[17]
In addition to symptoms (hot flushes/flashes, night sweats, mood changes, arthralgia and vaginal dryness), the physical consequences of menopause include bone loss, increased central abdominal fat, and adverse changes in a woman's cholesterol profile and vascular function.[17] These changes predispose postmenopausal women to increased risks of osteoporosis and bone fracture, and of cardio-metabolic disease (diabetes and cardiovascular disease).[17]
Medical professionals often define menopause as having occurred when a woman has not had any menstrual bleeding for a year.[2] It may also be defined by a decrease in hormone production by the ovaries.[18] In those who have had surgery to remove their uterus but still have functioning ovaries, menopause is not considered to have yet occurred.[17] Following the removal of the uterus, symptoms of menopause typically occur earlier.[19] Iatrogenic menopause occurs when both ovaries are surgically removed along with uterus for medical reasons.
The primary indications for treatment of menopause are symptoms and prevention of bone loss.[20] Mild symptoms may be improved with treatment. With respect to hot flashes, avoiding smoking, caffeine, and alcohol is often recommended; sleeping naked in a cool room and using a fan may help. The most effective treatment for menopausal symptoms is menopausal hormone therapy (MHT).[15][20] Non-hormonal therapies for hot flashes include cognitive-behavioral therapy, clinical hypnosis, gabapentin, fezolinetant or selective serotonin reuptake inhibitors.[21][22] These will not improve symptoms such as joint pain or vaginal dryness which affect over 55% of women.[20] Exercise may help with sleeping problems. Many of the concerns about the use of MHT raised by older studies are no longer considered barriers to MHT in healthy women.[20] High-quality evidence for the effectiveness of alternative medicine has not been found.[6]