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