gynecology and obstetrics
Menopause
Introduction
Menopause is the permanent cessation of menses (amenorrhea) due to loss of ovarian follicular function. Clinical manifestations may include hot flushes, night sweats, sleep disruption, and genitourinary syndrome of menopause (symptoms and signs due to estrogen deficiency, such as vulvovaginal atrophy). Diagnosis is clinical, based retroactively on the absence of menses for 12 months. Manifestations may be treated (eg, with lifestyle modification, complementary and alternative medicine, nonhormonal therapy, and/or hormone therapy). In the United States, the average age of physiologic menopause is 51 years old. Factors such as smoking, living at high altitude, and undernutrition may cause menopause to occur at a younger age. The aging of the female reproductive system before and after menopause is described in stages (see table). Reproductive stage:Includes the time from menarche through the menopausal transition Perimenopause:Refers to several years (duration varies greatly) before and the 1 year after the last menses; typically the most symptomatic phase because hormone levels are fluctuating Menopausal transition:Occurs during the perimenopause stage; includes the typically 4 to 8 years that lead up to the final menstrual period; characterized by changes in the menstrual pattern; divided into early and late stages Postmenopause:Refers to the time after the final menstrual period; divided into early and late stages The menopausal transition lasts longer in women who smoke and in women who were younger at onset of menopausal transition ( General references ). Black women experience a longer menopausal transition than White women ( Primary Ovarian Insufficiency (primary ovarian insufficiency) is cessation of menses due to noniatrogenic ovarian failure before age 40. Contributory factors are thought to be primarily genetic or autoimmune. 