Menopause is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Natural menopause: defined retrospectively after 12 consecutive months of amenorrhea in a nonpregnant woman ≥40 years of age:
    • Results from loss of ovarian activity
    • Not associated with a pathologic etiology
  • Perimenopause/menopausal transition (MT): defined as the period from the onset of irregular menses to the final menstrual cycle. Begins on average 4 years before menopause; starts at mean age of 47 years
  • Postmenopause: usually >1/3 of a woman’s life
  • Primary ovarian insufficiency: irregular or cessation of menses before age 40 years
  • Surgical menopause: Removal of functioning ovaries leads to immediate menopause.

Epidemiology

  • The median age of menopause is 51 years.
  • 5% of women undergo menopause after age 55 years; another 5% between ages 40 and 45 years
  • Occurs earlier in Hispanic women and later in Japanese American women as compared with Caucasians
  • Tobacco use hastens menopause by approximately 2 years.

Incidence
In the United States, 1.3 million women reach menopause annually.

Etiology and Pathophysiology

Normal physiologic process:

  • As women age, the number of ovarian follicles decreases: Ovarian production of estrogen varies and then decreases. Follicle-stimulating hormone (FSH) production varies and then increases.
  • Inadequate estradiol production leads to absence of the luteinizing hormone (LH) surge and failure to ovulate. These cycles result in anovulation and lack of progesterone production.
  • Eventual failure to produce estradiol leads to thinning of endometrial lining and eventual menses cessation.
  • Estrone (produced by adipose tissue) becomes the dominant form of estrogen during menopause.

Risk Factors

  • Aging
  • Oophorectomy/hysterectomy
  • Sex chromosome abnormalities (e.g., Turner syndrome and fragile X syndrome)
  • Family history of early menopause
  • Chemotherapy and/or pelvic radiation

General Prevention

Menopause is physiologic event. Increased risk of long-term medical issues includes cardiovascular disease (CVD) and osteoporotic fractures:

  • Decrease risk of CVD by:
    • Increased exercise; healthy diet and weight loss
    • Avoiding smoking
    • Treating hypertension (HTN), hyperlipidemia (HLD), diabetes mellitus (DM)
  • Decrease risk of osteoporotic fractures by:
    • Weight-bearing exercise and fall prevention
    • Avoiding smoking/excessive alcohol intake
    • Dietary calcium of 1,200 mg/day
    • Adequate vitamin D (800 to 1,200 IU daily)
    • Prevention of early menopause. Using epidemiologic data, there was a 17% reduced risk of early menopause in women with higher vitamin D (528 IU/d) versus low vitamin D intake (148 IU/d) and a modest decrease in risk with higher calcium intake (1,246 mg/d) when they came from dairy sources rather than nondairy sources (1).

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Citation

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Menopause ID - 116376 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116376/all/Menopause PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -