Menopause is defined as the cessation of spontaneous menstrual cycles. There are two stages of menopause: climacteric and postmenopause.
During the climacteric period there is a decline in ovarian function. Although a woman may continue to have periodic uterine bleeding, such cycles may be anovulatory (without ovulation). During this time estrogen production diminishes and a woman may experience early signs of estrogen deficiency, such as vasomotor symptoms, even though she still has periodic bleeding.
The postmenopause period occurs after menopause and usually accounts for more than a third of a women's total life.
The average age of menopause is 51. It is unrelated to the age of the menarche (first menses). Virtually all women will be postmenopausal by age 58. If the menopause occurs before age 30, it is defined as premature menopause and may be associated with abnormalities of the sex chromosomes. A karyotype is indicated in such young women to rule out the presence of a Y chromosome.
Symptoms of menopause include a cessation of menses - either abruptly or preceded by a period of irregular cycles and/or diminished bleeding. Vasomotor symptoms (hot flashes, sweating) are common, as are psychologic symptoms - depression, nervousness, insomnia.
Atrophy of epidemal tissue can affect several areas. Vaginal atrophy causes dyspareunia (painful menses). Urinary tract atrophy causes stress or urge urinary incontinence. Skin atrophy causes wrinkles.
Menopause is also associated with osteoporosis (which can cause fractures), and arteriosclerosis - coronary artery disease.
There are three main causes of menopause: Physiologic - when due to depletion of oocytes; Surgical - when due to removal of functioning ovaries because of disease or incidental to hysterectomy; and Medical - as a result of treatment of endometriosis (danazol [Danocrine] or GnRH analogues) or of breast cancer (antiestrogens). Menopause may also occur after cancer chemotherapy and be permanent or reversible.
There are no recommended labs for menopause.
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