Menarche to Menopause: Difference between revisions

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== Introduction ==
== Introduction ==
Consider this. Okay. Factoring in the average life span, approximately 82 years based on US stats, and ages of onset, rounding off to the nearest whole number, a woman will spend only 12% of her life from birth and infancy to menarche and 40% of her life after menarche and through her reproductive years. And this can include pregnancy of course, and 40% of her life, 40% of her life from menopause through her post-menopausal years. So we've given a lot of attention to pregnancy, which, conception to birth to the end of the postpartum period, 12 months or 21 months in a complicated case, and that's about 1-2% of a woman's total lifespan. So just saying that 12% leading up to menarche, and then 40% in the menopause transition, we really should be focusing more on the menopause transition.
If we divide a females life into 4 main categories, she will spend approximately 12% of her life from birth to menarche, approximately 40% after menarche and through her reproductive years and approximately 40% from menopause through her post-menopausal years. Pregnancy and the postpartum can take from 12 to 24 years, for a complicated case, which works out to possibly 2% of her life. Women spend a great deal of time preparing for and understanding pregnancy and birth, but don't seem to apply the same understanding and consideration to the other aspects of their health, that includes menarche and menopause. We should be focusing understanding on these transitions in life and preparing adequately for them.
 
Consider this, in her lifespan a Female will spend:
 
* only 12% of her life from birth & infancy to menarche
 
* 40% of her life after menarche and through her reproductive years (this may include pregnancy)
 
* 40% of her life from menopause through her post menopausal years
 
* 1%-2% /pregnancy, (conception, birth, to the end of the postpartum period of 12 months or 21 months in complicated cases)


==== Complex NORMAL developmental processes ====
==== Complex NORMAL developmental processes ====
*  
*  
                         Puberty                     Sexual                             Climacteric               Post-Climacteric
                             Puberty                     Sexual                             Climacteric                         Post-Climacteric


Infancy          Adolescence             Maturation         Menopause Transition    Post-menopause
Infancy          Adolescence             Maturation               Menopause Transition              Post-menopause


                                                          Reproductive
                                                            Reproductive






=== Puberty ===
puberty is the lead up to menarche  
puberty is the lead up to menarche  


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An idealised menstrual cycle is 28 days long. Day one is the menses, that's when the bleeding starts. And normally this lasts for five to seven days. Menses is included in the follicular phase. After bleeding, the endometrial lining, that's the inner lining of the uterus, begins to thicken until the egg is released. And that's when ovulation occurs, that's when the egg is released. In the luteal phase, the egg is fertilised and implants in the thickened endometrium. And if it's not fertilised, then the egg and the thickened portion of the endometrium, they're broken down for expulsion and the girl begins to bleed again, and the cycle begins all over.
An idealised menstrual cycle is 28 days long. Day one is the menses, that's when the bleeding starts. And normally this lasts for five to seven days. Menses is included in the follicular phase. After bleeding, the endometrial lining, that's the inner lining of the uterus, begins to thicken until the egg is released. And that's when ovulation occurs, that's when the egg is released. In the luteal phase, the egg is fertilised and implants in the thickened endometrium. And if it's not fertilised, then the egg and the thickened portion of the endometrium, they're broken down for expulsion and the girl begins to bleed again, and the cycle begins all over.


Menarche                    
=== Menarche                   ===
 
* Occurs at the beginning of the reproductive stage
* Occurs at the beginning of the reproductive stage
* Marked by the first menstrual period
* Marked by the first menstrual period
* Menarche – mēn (month) + arkhē (beginning)  It is when the first ‘period’ starts. It occurs during the late stages of puberty and signals the probability of ovulation and the beginning of a woman’s reproductive years.
* Menarche – mēn (month) + arkhē (beginning)  It is when the first ‘period’ starts. It occurs during the late stages of puberty and signals the probability of ovulation and the beginning of a woman’s reproductive years.
Menopause
=== Menstruation ===
A menstrual period defined as “the monthly shedding of the functional layer (the endometrial lining) of the uterus.” It occurs approximately every 28 days. (hence it ‘cycles’, it is ‘periodic’). This process occurs when the egg (ovum) is not fertilied.
 
 
Cycles are erratic at beginning
* Follicles are present in a high % of girls but ovulation may not occur until after a half dozen menstrual cycles
* Monthly cycles may not regulate for years
 
* There are thousands of euphemisms for a menstrual period throughout the world. (more than 5,000 to be more exact)
 
=== Menopause ===
* Occurs at the end of the reproductive stage
* Occurs at the end of the reproductive stage
* Marked by the final menstrual period
* Marked by the final menstrual period
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the reproductive stage is separated from the menopausal transition. However, in practice, the late reproductive period will overlap into the menopausal transition. So more commonly it's known as the perimenopause
the reproductive stage is separated from the menopausal transition. However, in practice, the late reproductive period will overlap into the menopausal transition. So more commonly it's known as the perimenopause


== Menstruation ==
A menstrual period defined as “the monthly shedding of the functional layer (the endometrial lining) of the uterus.” It occurs approximately every 28 days. (hence it ‘cycles’, it is ‘periodic’). This process occurs when the egg (ovum) is not fertilied.
Cycles are erratic at beginning
* Follicles are present in a high % of girls but ovulation may not occur until after a half dozen menstrual cycles
* Monthly cycles may not regulate for years
* There are thousands of euphemisms for a menstrual period throughout the world. (more than 5,000 to be more exact)
*  
*  


Line 266: Line 257:


== References ==
== References ==
STRAW CHART
Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, Sherman S, Sluss PM, De Villiers TJ, STRAW+ 10 Collaborative Group. Executive summary of the Stages of Reproductive Aging Workshop+ 10: addressing the unfinished agenda of staging reproductive aging. The Journal of Clinical Endocrinology & Metabolism. 2012 Apr 1;97(4):1159-68.
Resources:
Resources:



Revision as of 20:21, 16 May 2022

Original Editor - Carin Hunter based on the course by Sue Piché
Top Contributors - Carin Hunter, Jess Bell, Kim Jackson, Wanda van Niekerk and Ewa Jaraczewska

Introduction[edit | edit source]

If we divide a females life into 4 main categories, she will spend approximately 12% of her life from birth to menarche, approximately 40% after menarche and through her reproductive years and approximately 40% from menopause through her post-menopausal years. Pregnancy and the postpartum can take from 12 to 24 years, for a complicated case, which works out to possibly 2% of her life. Women spend a great deal of time preparing for and understanding pregnancy and birth, but don't seem to apply the same understanding and consideration to the other aspects of their health, that includes menarche and menopause. We should be focusing understanding on these transitions in life and preparing adequately for them.

Complex NORMAL developmental processes[edit | edit source]

                          Puberty                     Sexual                      Climacteric             Post-Climacteric

Infancy          Adolescence             Maturation         Menopause Transition    Post-menopause

                                                      Reproductive


Puberty[edit | edit source]

puberty is the lead up to menarche

It's the transitional stage that alerts providers and clients to the upcoming event. Regular monitoring with client health checks should be done and a conversation initiated by the provider about the time the client is six years old. Now, obviously this conversation is with the client's parents or guardians, but it needs to be done beforehand and preparation is key in these kinds of things. There are a number of hormones and organs that begin this process. The main players are the HPG axis and the adrenal glands. The HPG axis consists of the hypothalamus and pituitary gland, they're up in the brain, and the gonads. In women they're the ovaries. So a pulsing release of gonadotropin-releasing hormone stimulates the pituitary gland to release two important hormones: LH, luteinising hormone, and follicle-stimulating hormone, FSH. Together, these two will start the ball rolling to produce the oestrogen needed to stimulate the secondary sexual characteristics along with the adrenals. Other hormones are also involved before puberty to mature the eggs in the ovaries and become key to maintaining the cyclic reproductive function.

Health visit monitoring. The onset of puberty for a female should be identified and monitored for evidence of supporting good health or to identify disease processes that may require treatment. Regular health visit monitoring should include a visual exam of external primary sex characteristics. Primary sex characteristics are internal and external genitalia. So, only the external genitalia needs to be visualised. Only if there's a problem would you do anything further than that. Later on, when you know the female is sexually active, then the internal primary sex characteristics can be examined regularly and should be. But, in this particular case, until menarche happens and until you know that that female is sexually active, you will do an external examination only, and all the average stuff. You would do height and weight and identify the appearance of any secondary sex characteristics and these are basic markers to be reviewed at each health visit.

Sexual Maturity Rating, SMR, better known as Tanner Stages is an objective classification system that providers use to document and track the development and sequence of secondary sex characteristics of children during puberty. Those are characteristics that appear during puberty so we can tell the boy humans from the girl humans. And in females, the most important are breast development and pubic hair growth, but other features show up like that rounded figure that we have, the hourglass figure, getting bigger hips, a slower ability to generate muscle mass, less upper body strength, and increased body fat composition. About two to two-and-a-half years after Tanner stage two, that's when the breasts are budding and a female will start to have her period. So once you identify that a female is in Tanner stage two, then two to two-and-a-half years after that, she will probably be starting her period. This is menarche. When she begins to bleed, this is the start of menstrual cycles and the reproductive stage.

At the beginning of these cycles, there's usually a lot of erratic hormone fluctuations, but eventually they should stabilise. Follicles are present in a high percentage of girls. However, ovulation does not occur until the girl has had an average of six regular menstrual cycles and monthly ovulation does not become regular for several years.

An idealised menstrual cycle is 28 days long. Day one is the menses, that's when the bleeding starts. And normally this lasts for five to seven days. Menses is included in the follicular phase. After bleeding, the endometrial lining, that's the inner lining of the uterus, begins to thicken until the egg is released. And that's when ovulation occurs, that's when the egg is released. In the luteal phase, the egg is fertilised and implants in the thickened endometrium. And if it's not fertilised, then the egg and the thickened portion of the endometrium, they're broken down for expulsion and the girl begins to bleed again, and the cycle begins all over.

Menarche                  [edit | edit source]

  • Occurs at the beginning of the reproductive stage
  • Marked by the first menstrual period
  • Menarche – mēn (month) + arkhē (beginning) It is when the first ‘period’ starts. It occurs during the late stages of puberty and signals the probability of ovulation and the beginning of a woman’s reproductive years.

Menstruation[edit | edit source]

A menstrual period defined as “the monthly shedding of the functional layer (the endometrial lining) of the uterus.” It occurs approximately every 28 days. (hence it ‘cycles’, it is ‘periodic’). This process occurs when the egg (ovum) is not fertilied.


Cycles are erratic at beginning

  • Follicles are present in a high % of girls but ovulation may not occur until after a half dozen menstrual cycles
  • Monthly cycles may not regulate for years
  • There are thousands of euphemisms for a menstrual period throughout the world. (more than 5,000 to be more exact)

Menopause[edit | edit source]

  • Occurs at the end of the reproductive stage
  • Marked by the final menstrual period
  • Exact timing of this period can not be forecast
  • Menopause – mēn (month) +  pausis (to cease) It is when the final menstrual ‘period’ (FMP) occurs. This occurs at the end of the reproductive years BUT can only be pinpointed in retrospect, when 12 months have passed without a period. 12 months after that FMP before we know it's an Final Menstrual period

  • Menopause Perimenopause to Postmenopause
    • Triggered by ovaries
      • viable follicles number less than 1,000
      • S&S begin to disrupt life
    • Normally begins between 45-58 yrs
    • End occurs after FMP – determined in retrospect, when post menopause starts

Fertility can not be guaranteed or ruled out Birth Control is an important discussion.

Now that you have the basics, we're going to slide into menopause. Fast forward in a female's lifespan into the late reproductive years, to a point where all those viable follicles number less than 1000. So then we're going to see the beginnings of the menopause transition. The beginning of this transition is defined as perimenopause, it's triggered by the ovaries when the egg count drops so low, whereas in a menarche transition with puberty, we saw that the stimulation came from the HPG axis, when the signal came from the brain and went through to the gonads. In this particular case, it's turned around. Now we're getting the gonads, the ovaries in a female, are creating the signal to say, hey, there's not enough eggs here.

So, all the signs and symptoms will start to disrupt a woman's life. And normally it begins around 45 to 58 years old. As we've already said, it can only be determined in retrospect, after the female has had no menstrual cycles for 12 months, that's a year. Then a woman enters the post-menopause stage. Menopause has been described as puberty in reverse or puberty part two due to the fact that much of the same mechanisms are involved, but those mechanisms behave differently. It is a transition, perimenopause and puberty are comparable regarding the signs and symptoms they affect, from a client perspective though.

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the reproductive stage is separated from the menopausal transition. However, in practice, the late reproductive period will overlap into the menopausal transition. So more commonly it's known as the perimenopause

Diagnosis of Disease[edit | edit source]

A functional diagnosis in order to provide direction and support for client care is made primarily by looking at signs and symptoms. Age of the female, younger women, eight to 16 years old, obviously menarche, or older women, 45 to 54 years old. You're looking at the menopause transition. Character of the menses, how often does it occur? How long is it? How heavy is the flow? Physical, emotional, mental changes. Breast budding, growth spurts, signs and symptoms in younger or older females, low energy, fatigue, moodiness, short-temperedness, difficulty concentrating, acne, bloating. Oh my gosh, the list goes on and on. Those signs and symptoms are enough to say whether this female is in the transition towards menarche or in the transition to menopause. So if you look at the stages, not all women progress from one stage to the next. Most women do, most women do however, but some move back and forth between the stages or skip a stage. Then this doesn't mean that they're not healthy. It's just some women do something different.

“Functional” Diagnosis

  • Age of female
    • Younger (8-16 yrs) or Older (45-54 yrs)
  • Character of Menses:
    • How often does it occur?
    • How long does it occur?
    • How heavy is the flow?
  • Physical & Mental changes:
    • Breast budding and growth spurt in younger females
    • Low energy/fatigue, moodiness, short temperedness, difficulty concentrating, acne, bloating, fluid retention…
    • Etc., etc., etc….

*Note: not all women progress from one stage to the next, most women do, but some move back and forth between stages or skip a stage…this doesn’t mean that they aren’t healthy.

Transitions[edit | edit source]

Now, with respect to these processes of transition, in both cases, the exact timing of this all-important menstrual period can't be forecasted. It can't. Providers can estimate probable timings from signs and symptoms. And as these all-important periods approach, well, fertility is questionable since we can't tell if the woman's eggs are viable or not, so a conversation regarding birth control is not just acceptable, it is essential. both these transitions are not diseases that need to be diagnosed

Puberty is the lead up to menarche.

  • a transitional stage that alerts providers & clients to the upcoming event. There are a number of hormones and organs that begin this process.
  • regular monitoring should be done
  • Conversation should be initiated by provider by approximately age 6 of client

HPG Axis[edit | edit source]

  • Controls & synchronizes
    • Adrenal gland maturation is an independent but interrelated process

Health visit monitoring:

  • Visual exam External Primary sex characteristics
  • Height/Weight
  • Identification of appearance of Secondary Sex characteristics
  • Prepubertal genital exam https://obgynkey.com/prepubertal-genital-examination/ Doctor visit https://www.shutterstock.com/search/doctor%2Bmeasuring%2Bheight%2Bchild?gender=female&mreleased=true

Sexual Maturity Rating (SMR) - Tanner’s Stages

https://quizlet.com/514600861/tanner-stages-flash-cards/

Signs & Symptoms (S&S)[edit | edit source]

Signs and symptoms:

Puberty to Menarche Perimenopause to Menopause
secondary sex characteristics more pronounced Vasomotor symptoms VMS (hot flashes/ night sweats)
Growth spurt vaginal dryness or Genitourinary Syndrome of Menopause (GSM)
Moodiness, short tempered, emotional moodiness, short tempered, emotional
low energy/fatigue low energy/fatigue
breast tenderness breast tenderness
muscle aches muscle aches
headaches headaches
abdominal cramps abdominal cramps
lower back pain lower back pain
difficulty concentrating difficulty concentrating
bloating, fluid retention bloating, fluid retention
joint pain joint pain
food cravings food cravings
acne acne
diarrhea/constipation diarrhea/constipation
trouble sleeping trouble sleeping

Providers should be approaching menopause in the same way as menarche:

  • -monitoring for normal functioning
  • -identifying issues early and treating
  • -initiating conversations prior to the transition at about age 6 with parent/guardian and 35 with client…regardless of whether the transition is asked about or not
  • -encouraging clients to make ‘healthy choices’ within their capability

Common Medical Concerns in the Menopause Transition that need identification and treatment include:[edit | edit source]

  • POI – Primary Ovarian Insufficiency (1% in US)
  • GUSM – Genitourinary Syndrome in Menopause (50-70% US)
  • Diseases of higher risk:
    • Cardiovascular (1 woman dies every minute from CVD)
    • Diabetes/Obesity
    • Osteoporosis
    • Dementia
    • Cancer (Breast & Uterine)

Common medical concerns in the menopause transition that need identification and treatment include primary ovarian insufficiency, POI. 1% of women in the US, I don't have stats for other places, but in the US that actually translates to quite a lot of women who have primary ovarian insufficiency. And that is when the ovaries stop working before the age of 40, and there's a number of reasons that could happen. And this is why we need to look for it so that we can try to figure out, is it something that needs to be treated? GSM or GUSM, genito-urinary syndrome in menopause is in 50 to 70% of US females when they hit the menopause transition. It's quite an uncomfortable condition where the vaginal walls and the vulva become so friable, that means so thin that they become easy to break down, so they feel possibly hot, they feel rough, like sandpaper. It's extremely uncomfortable. There can be bleeding when wiping after toileting. So this is a condition that needs to be diagnosed as soon as possible. This particular condition cannot be ameliorated. So it needs to be stopped. It needs to have treatment immediately. it's not urgent, but it's important.

Okay, diseases with high risks that skyrocket after menopause include cardiovascular. One woman dies every minute from cardiovascular disease. Diabetes and obesity, osteoporosis, dementia, cancer, both breast and uterine cancer, the list goes on, but those are the top ones. So you can see where regular assessments become quite important and prevention and treatment are high on our list as providers of what we need to do for clients.

Regular assessments need to include blood work to establish baselines and/or eliminate other things, such as thyroid, diabetes, et cetera. Lipid levels should be done every three years, starting at age 40. More often if there's a risk for cardiovascular disease. Calcium, vitamin D levels, hormones only if there's an indication. Honestly, unless you're looking for indicators of POI, the primary ovarian insufficiency, you're not going to need any hormone levels. It's not going to tell you whether someone's going through the menopause transition or not. Height, weight, ECG, even if for baseline an ECG is an important thing to have. Height and weight should be normal markers that you're collecting all the time. Assess for sleep and rest habits. Sleep apnoea is prevalent in this transition. Assess for depression as its prevalence increases throughout the transition. Prescriptions that are immediately helpful. Anything that's going to treat symptoms, acne cream, helping to stop someone from smoking, any kind of antidepressant medication, something to help someone sleep, things that are going to help them in the short term, and then consider referrals. Referrals that are immediately helpful, such as OB-GYN appointments, gynaecology referrals and endocrinologist referrals, physiotherapy, pelvic floor physiotherapy specialists. If there's a genito-urinary syndrome going on, it can help with that as well. Mental health and CBT, you can send to a counsellor or you can send to psychiatry. I have found in the past, generally counsellors are better because CBT has been found far more often to be productive in alleviating symptoms. Sleep clinics. Whatever is needed at this point in time, get on these things early and get the referrals out. Pap tests. Other tests that you could do in your office as opposed to sending them out to gynaecologists, but still, referrals to gynaecologists are important in order for follow-up because there may be things that you might miss, and there may be things that that particular gynaecologist will pick up. Mammograms, beginning at around age 40. There are different policies in different countries, so the ages that I give you depends on where you're living, of course, and healthcare that's provided or not provided. So mammograms beginning at around age 40, 45 and continuing every three years, approximately, unless there's an indication. Colonoscopy at age 55 and then afterwards every five years or as indicated. Any follow-up appointments that there might be. Bone density scan, at age 40, you should at least send a female for a bone density scan as a baseline because osteoporosis is so prevalent and bone begins to thin after age 30, you only build up your bone to age 30. So after that, I mean, you could have something happen anytime. And you need to repeat that every five years, unless there's an indication. If a female has a fracture, it needs to be done more often.

Healthy choices. Help your client to make healthy choices. And as I indicated earlier, healthy choices are within the parameters of what the client can do. In different countries, there are different choices that they may or may not have, and in different socioeconomic status. If you are in a poverty situation, then you may not have the same choices as someone else, or if your healthcare doesn't cover certain things. But the biggest, the number one thing that you can do is advise your clients to exercise at any age. Any age. From children on to 80-year-old women. Exercise, and you are never too old to start. It is the number one research-based thing that you can do to alleviate signs and symptoms of menopause and the menopause transition and it is recommended by every organisation that I know that supports research for menopause. Diet and nutrition is aimed at maintaining weight, no fad diets or weight loss. That's not the point. The point is maintaining a regular weight and eating a variety of foods. Stop smoking if you do, if you do smoke, stop smoking. If you don't, don't start. So if you're a younger woman, don't start. Keep alcohol intake within moderation. Moderation means one or less alcoholic drink a day, less being the preferable there, but once you get into two drinks a day, when you're in the menopausal transition phase, it increases your breast cancer risk by approximately 20%. So, all the things that we're recommending, there's reasons behind the recommendations. Sleep, make sure you're getting enough sleep, six to eight hours per night, and you find things that you can do to relax and de-stress because those will help decrease your signs and symptoms with regards to the menopause transition as well. So these are all things that you need to talk to your client about and refer.

Regular Assessments to include:[edit | edit source]

  • Blood work – to establish baselines +/or eliminate other things thyroid, diabetes, etc, lipid levels every 2-3 yrs starting at age 40 yrs more often if CVD is a risk, calcium & Vit D, Hormones ONLY if there’s an indication
  • Height/Weight/ECG baseline
  • Bone density scan (age 40 yrs at least for baseline, repeat every 5 years as indicated)
  • Assess for sleep/rest habits (sleep apnea is prevalent here)
  • Assess for depression as it’s prevalence increases
  • Prescriptions that are immediately helpful (acne cream, smoking cessation aids, etc)
  • Referrals that are immediately helpful (Physio, PFPT, Mental health-CBT, Sleep Clinic, etc)
  • Gynecologist &/or Endocrinologist referral
  • Pap test
  • Mammogram beginning age
  • Colonoscopy age 55
  • Follow up Appointment
  • Encourage Clients to track S&S, to facilitate & direct care and review this regularly

Healthy Choices[edit | edit source]

  • **Exercise (aerobic, strengthening and balance) you can include sex in this repertoire
  • Diet/Nutrition
  • Stop smoking if you do, don’t start if you don’t
  • Keep alcohol intake within moderation moderation
  • Sleep
  • Relax/De-stress

Summing Up:[edit | edit source]

12% of a female’s lifespan is spent in ‘lead up’ to menarche, more people are aware these milestones and predictive benchmarks, like Tanners stages, but there’s a gap in the knowledge and practice regarding preparation for menopause.

In order to understand menopause it’s essential to understand the mechanisms that exist throughout the reproductive stage, that’s what we’ve discussed here. “The tip of the menopause iceberg.”

40% of a female’s lifespan will be spent in the menopause transition, therefore there is a significant amount more information that would focus on prevention, screening and treatment options. This is a positive period in a woman’s life provided she is prepared and given adequate health care.

Thank you for joining me. I hope this has been helpful.

There’s some reading material and videos as well as helpful references.


This course is directed towards ‘normal’ female aging, women born with ovaries.

Those trans & non-binary persons must be looked at independently since studies are lacking in order to provide adequate general information.

By understanding the ‘norm’ we can better deal with irregularities

Before we get too far ahead of ourselves, I want to outline the normal transitions of the female reproductive lifespan. In 2001, Stages of Reproductive Aging Workshop, STRAW, another acronym because medical people like to use acronyms, they gave us a standard for reproductive ageing. Now in 2011, STRAW was updated and modified to STRAW+10, and it's still used today. It's the gold standard to identify stages within the sexual reproductive periods of a woman's lifespan. This figure is the STRAW outline. From a client point-of-view, it's a bit complicated, but as a provider, it is the springboard of female care throughout the lifespan.

Links to helpful pages[edit | edit source]

References[edit | edit source]

STRAW CHART

Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, Sherman S, Sluss PM, De Villiers TJ, STRAW+ 10 Collaborative Group. Executive summary of the Stages of Reproductive Aging Workshop+ 10: addressing the unfinished agenda of staging reproductive aging. The Journal of Clinical Endocrinology & Metabolism. 2012 Apr 1;97(4):1159-68.

Resources:

1) Menopause Practice: A Clinician’s Guide, 6th Edition. C.J. Crandall, Editior-in-Chief. North American Menopause Society, 2019

2) Female Development, 2021, Remien & Pillarisetty, National Library of Medicine, NIH

3) Physiology of Menarche, 2021, Lacroix/Gondal/Langaker, National Library of Medicine, NIH

4) Tanner Stages, 2021, Emmanuel & Bokor, National Library of Medicine, NIH

5) The Menopause Manifesto, Jen Gunter PhD OB/GYN, Penguin Random House Canada, 2021

6) Menopause Preparedness: perspectives for patient, provider, and policymaker considerations, 2021, Menopause: The Journal of the North American Menopause Society, Vol 28, No.10 pp.1186-1191

7) The Complete Guide to Menopause, Annice Mukherjee PhD, Penguin Random House UK, first pub by Vermilion, 2021

Videos:

What is Menarche? Everything you need to know.- May 2021 (4 ½ mins)

Medical Centric

https://www.youtube.com/watch?v=kNlmOe-e23k


Menstrual cycle, NHS site video (2:41 mins) October2020

https://www.nhs.uk/conditions/periods/fertility-in-the-menstrual-cycle/

What Really Happens to Your Body During Menopause - June 2021 (5 mins)

Dr Jen Gunter, TED Talks

https://www.ted.com/talks/jen_gunter_what_really_happens_to_your_body_during_menopause?language=en


Recommended for Providers:Recommended for Providers:

Menopause Health Tool, Dr Jean Hailes

https://www.jeanhailes.org.au/health-professionals/tools

Practitioner’s Toolkit, Monash University 2014

https://www.monash.edu/medicine/sphpm/units/womenshealth/toolkit-management-of-the-menopause

The toolkit is now published online in the journal Climacteric and can be accessed in full at http://informahealthcare.com/doi/full/10.3109/13697137.2014.929651

Menopause Preparedness Fact Sheet, The Society of Women’s Health Research -October 2021,

https://swhr.org/swhr_resource/menopause-preparedness-fact-sheet/

Recommended for Clients & Parents/Guardians :

Menopause Fact Sheet, August 2019, Dr Jean Hailes, Women’s Health, Available in English, Arabic, Chinese (Simplified), Farsi, Greek, Hindi, Italian, Turkish and Vietnamese. (This project was funded by the Victorian Government)

https://www.jeanhailes.org.au/resources/menopause-multilingual-fact-sheets

Menstrual Calendar, for tracking perimenopause phase, NAMS, 2015

http://www.menopause.org/docs/default-source/2015/menonote-menstrual-calendar-english.pdf

Video: Am I Normal?, Kids Health.org (2 mins)

https://kidshealth.org/en/kids/puberty-normal-video.html


Hormone Health Network from the Endocrinsociety (Meno Map) https://www.hormone.org/menopausemap/index.html

Red Hot Mamas

https://redhotmamas.org/

Menopause Barbie

https://menopausetaylor.me/

The North American Menopause Society

https://www.menopause.org/for-women

US Department of Health and Human Services

https://www.womenshealth.gov/menopause/menopause-symptoms-and-relief

Healthy Women

https://www.healthywomen.org/content/blog-entry/7-effective-ways-deal-menopause Canadian Society of Obstetricians and Gynaecologists https://www.menopauseandu.ca/

https://www.yourperiod.ca/normal-periods/menstruation-around-the-world/

https://www.menopauseandu.ca/

https://www.menopause.org/for-women

https://www.imsociety.org/

  • Menopause Map (link here) is a great interactive tool to start with to personalize your journey.
  • https://www.hormone.org/menopausemap/index.html