What are the other Names for this Condition? (Also known as/Synonyms)

• Change of life 

What is Menopause? (Definition/Background Information)

• Menopause is a condition that occurs in females where menstruation permanently ends. Officially, it is defined as a condition that occurs twelve months after the completion of your last menstrual period.
• Females experience menopause when their ovaries stop producing estrogen and progesterone. This results in the conclusion of menstrual periods.
• Menopause usually occurs in a female’s 40s or 50s and results in the inability to reproduce anymore.
• It is also common for women to experience physical and emotional stress due to menopause. In most cases, the signs and symptoms associated with menopause are caused by hormonal changes and last for about one year. As women adjust to having lower levels of female hormones, their symptoms ease and they are able to transition into their post-menopausal life. 

Who gets Menopause? (Age and Sex Distribution)

• Females who have menstrual periods and are between the ages of 40 and 50 experience menopause. The average age in the United States is 51 years.
• Females with menopause experience declining levels of estrogen and progesterone.
• Males in their 40s and 50s can also experience menopause, although it is more commonly termed andropause. In men, declining testosterone levels are observed.

What are the Risk Factors for Menopause? (Predisposing Factors)

• Menopause is a normal part of the aging process in females. It is almost certain that females who have begun menstruating will experience menopause at some point in their life.
• Menopause can, however, occur earlier in life due to the following factors:
  • Radiation or chemotherapy
  • Ovarian failure
  • Smoking
  • Hypothyroidism (lack of thyroid hormone production)
  • Malfunctioning adrenal glands (leads to lower hormone production)
  • Low body weight
  • Genetic factors (family history of early menopause increases your likelihood of experiencing early menopause)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Menopause? (Etiology)

• Menopause is caused by the decline in estrogen and progesterone production by the ovaries. These hormones are important in regulating menstruation and producing eggs, so when their production is reduced, menstruation declines and eventually stops.
• Menopause can also be induced by a hysterectomy. During this procedure, the uterus and ovaries are removed. Since the ovaries are removed from the body, the body is no longer able to produce estrogen and progesterone, which results in the abrupt stop of menstrual periods. 

What are the Signs and Symptoms of Menopause?

Signs and symptoms of Menopause stem from the changes that occur in a woman’s body during this time, including hormonal fluctuations – namely, of estrogen and progesterone – as the woman ceases to ovulate.

Signs and symptoms of Menopause include:

• Vaginal dryness: lubrication of the vaginal tract is tied to progesterone and estrogen levels. As these decline with Menopause, the vagina may become dry and sex may cause pain and discomfort.
• Night sweats: clammy skin and excessive sweating during sleep may cause discomfort and insomnia
• Hot flashes: periods of warming and flushing sensations accompany the changes to the sexual system that occur during Menopause
• Mood swings: abrupt changes in mood, from depression to anxiety can occur
• Weight gain: appetite and metabolism changes during Menopause will affect weight. The weight gain may be sudden or gradual
• Thin hair:  shedding of hair thinning of hair strands follow changes in the hormones estrogen and progesterone during Menopause. This can cause emotional distress
• Dry and thin skin: secretion of lubricating oils is altered, which causes dryness, cracking, and occasional bleeding of skin during Menopause. 
• Urinary incontinence: occasional loss of control of urination may occur in some. 
• Bone loss: also known as osteoporosis, a woman may lose 1% of the density of her bones every year during and after menopause
• Altered cholesterol levels:  metabolism changes cause altered distributions of fatty acids in the body, shifting the normal levels of cholesterol, the body’s principal fat transportation molecule. The increased cholesterol levels can result in increased risk for heart attacks. 
• Flushed skin – accompany sensations of warmth and redness
• Constipation – changes to the circadian rhythm, gut microbiota, and other fluctuations may cause constipation and other bowel irregularities
• Changes in the shape and size of the breast – altered levels of estrogen and progesterone may decrease the firmness and size of the breast, and cause tender nipples
• Muscle loss – decreased muscle synthesis and maintenance along with lowered metabolism
• Fatigue – altered metabolism changes energy production and consumption, and may contribute to lethargy and fatigue
• Irritability – increased sensitivity to negative stimuli and heightened reactions to normally subtle negative impulses
• Reduced libido – a decreased sex drive follows drops in the female sex hormones estrogen and progesterone, which occur during Menopause
• Depression – feelings of loss, loneliness, and sadness
• Insomnia – overactivity, night sweats, and anxiety may make it difficult to fall and stay asleep. Additionally, it may cause a woman in Menopause to wake earlier than normal.

Perimenopause refers to the months leading up to menopause. Perimenopause may be marked by the same signs and symptoms as Menopause, but milder and including irregular menstrual periods.

How is Menopause Diagnosed?

• In most cases, the appearance of signs and symptoms associated with menopause are enough to make a diagnosis.
• Usually, your doctor will not ask for further tests to confirm the diagnosis. If, however, uncommon problems are observed, a blood test will be recommended. The blood test is used to measure follicle-stimulating hormone (FSH) levels, estrogen levels, and thyroid-stimulating hormone (TSH) levels.
  • An increase in FSH and a decrease in estrogen indicate that menopause is occurring
  • Abnormal TSH levels indicate that hypothyroidism is present; the symptoms of hypothyroidism are similar to menopause which is why you may observe similar signs

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Menopause?

• After menopause has occurred, your risk for certain medical conditions increases. These conditions include:
  • Heart disease - declined estrogen levels increase cardiovascular disease risk
  • Osteoporosis and injury - decreased estrogen and progesterone levels lead to weakening bones; as bones weaken, the likelihood breaking bones or fracturing bones is increased
  • Urinary incontinence (involuntary release of urine) - menopause results in weakened vaginal wall elasticity; when this occurs, the ability to control urine release is declined
  • Loss/decline in sexual function - during menopause, vaginal dryness occurs which can make sex uncomfortable and painful
  • Weight gain - metabolism slows down when menopause occurs which makes it harder to burn off calories and can result in weight gain
  • Macular degeneration - this age-related eye disorder has been found to be more prominent in women who have experienced menopause

How is Menopause Treated?

• Since menopause is a natural phenomenon that occurs in menstruating women, it does not require any medical treatment.
• Treatments are, however, available to relieve the signs and symptoms associated with menopause. These include:
  • Hormone replacement therapy - estrogen is replaced in the body to help maintain higher levels; aids in preventing bone loss, reducing hot flashes
  • Vaginal estrogen - estrogen is placed into the vagina via a tablet, ring, or cream; reduced vaginal dryness
  • Anti-depressants - used to manage hot flashes and reduce mood changes
• Studies have found, however, that hormone replacement therapy may have more risks than benefits. The Women’s Health Initiative found that women who underwent hormone replacement therapy had an increased risk for breast cancer, heart disease, stroke, and blood clots.
• Medical professionals also suggest regular exercise and a healthy, well-balanced diet to keep symptoms of menopause from getting out of control.

How can Menopause be Prevented?

• Menopause cannot be prevented in women who are menstruating. As they get older, they are certain to go through menopause as their ovaries decline estrogen and progesterone production. 

What is the Prognosis of Menopause? (Outcomes/Resolutions)

• While the change in estrogen and progesterone levels are difficult to cope with, as time passes, women with menopause are able to return to relatively good health. Symptoms ease as time passes and it becomes easier to cope with the end of menstruation.
• It is important, however, to maintain an healthy diet and exercise regularly to reduce your risk of developing the complications associated with menopause. 

Additional and Relevant Useful Information for Menopause:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/womens-health/