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]
- irregular bleeding or spotting, during peri-menopause
- hot flashes
- vaginal dryness
- sexual function
- sleep disturbances
- mood symptoms
- joint pain
- cognitive changes
Longterm consequences of low estrogen:
- 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.[4]
Late reproductive years:
- female 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:
- is 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]
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.
- ↑ 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.
