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Disease: Menopause Menopause
Category: Gynecological diseases
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Disease Definition:

The permanent end of menstruation and fertility, defined as occurring 12 months after the last menstrual period, is called menopause.


The emotional and physical symptoms of menopause can disrupt a woman's sleep, sap her energy and, at least indirectly, trigger feelings of sadness and loss, even though menopause is a natural biological process, not a medical illness.


For emotional symptoms, mistaken beliefs about the menopause transition are partly to blame; however, the physical symptoms are caused by hormonal changes. This means that menopause will not snuff out the sexuality and femininity of a woman, and it doesn't mean that the end is near; a woman has still got as much as half her life to go. As a matter of fact, when a woman gets to her menopause, she may be one of the many women who find it liberating to stop worrying about periods and pregnancy.


Moreover, a woman shouldn't hesitate to get treatment if she is having severe symptoms, even though menopause is not considered an illness. There are many treatments that are available, from lifestyle adjustments to hormone therapy.

Work Group:

Prepared by: Scientific Section

Symptoms, Causes


Until it's been one year since a woman's final menstrual period, she doesn't actually "hit" menopause.
Long before the one-year anniversary of a woman's final period, the signs and symptoms of menopause often appear, such as:


  • Decreased fertility
  • Increased abdominal fat
  • Loss of breast fullness
  • Hot flashes
  • Sleep disturbances
  • Vaginal dryness
  • Thinning hair
  • Mood swings
  • Irregular periods


For preventive health care as well as care of medical conditions that may occur with aging, it's important to see the doctor during the years leading up to menopause (perimenopause) and the years after menopause (postmenopause).


A woman may want to see her doctor to determine whether she's pregnant if she skipped a period but isn't sure she's started menopause. The doctor may do a pelvic examination, take a medical history and, if appropriate, order a pregnancy test.
If a woman is bleeding from her vagina after menopause, she should seek medical advice.


The causes of menopause include:


A hysterectomy that removes the uterus but not the ovaries usually doesn’t cause menopause. The ovaries still release eggs and produce estrogen and progesterone, though the woman no longer has periods. However, without any transitional phase, an operation that removes both the uterus and the ovaries (total hysterectomy and bilateral oophorectomy) does cause menopause. In this case, the periods stop immediately, and the woman is likely to have hot flashes and other menopausal signs and symptoms.

Natural decline of reproductive hormones:

The ovaries start making less estrogen and progesterone; the hormones that regulate menstruation, as a woman approaches her late 30s. Fewer potential eggs are ripening in a woman's ovaries each month, and ovulation is less predictable during this time. The post-ovulation surge in progesterone, which is the hormone that prepares the body for pregnancy, becomes less dramatic as well; and fertility declines partially due to these hormonal.


When a woman reaches her 40s, these changes become more pronounced. Until the ovaries stop producing eggs and the woman has no more periods, her menstrual periods may become longer or shorter, heavier or lighter, and more or less frequent.

Primary ovarian insufficiency:

Before the age of 40, approximately 1% of women experience menopause. Although usually no cause can be found for primary ovarian insufficiency, but when the ovaries fail to produce normal levels of reproductive hormones, primary ovarian insufficiency may result in menopause stemming from genetic factors or an autoimmune disease.

Chemotherapy and radiation therapy:

Causing symptoms like hot flashes during the course of treatment or within three to six months, these cancer therapies can induce menopause.



Menopause is commonly divided into the following stages because the menopausal transition occurs over months and years:


Even though a woman is still menstruating in this stage, it's the time she begins experiencing menopausal signs and symptoms. She might have hot flashes and other symptoms, and her hormone levels rise and fall unevenly. Perimenopause may last for four to five years or longer. Though it's still possible to get pregnant during this time, but it's quite unlikely.


A woman reaches menopause once 12 months have passed since her last period. In this stage, the ovaries produce much less estrogen and no progesterone, and they don't release eggs. Postmenopause is what we call the years that come after that.



After menopause, several chronic medical conditions can develop:

Weight gain:

During menopausal transition, many women gain weight. Just to maintain their current weight, women may need to exercise more and eat less, perhaps as many as 200 to 400 fewer calories a day.


Increasing the risk of osteoporosis, one may lose bone density at a rapid rate during the first few years after menopause. Leading to an increased risk of fractures, osteoporosis causes bones to become brittle and weak. To get adequate calcium and vitamin D, about 1,200 to 1,500 milligrams of calcium and 800 international units of vitamin D daily is important during this time because postmenopausal women are especially susceptible to fractures of the spine, hip and wrist. Strength training and weight-bearing activities such as jogging and walking are especially beneficial in keeping the bones strong. So it's also important to exercise regularly.

Cardiovascular disease:

The risk of cardiovascular disease increases when the estrogen levels decline. The leading cause of death in women as well as in men is heart disease. Nonetheless, to reduce the risk of heart disease, one can do a great deal. Eating a diet low in saturated fats and plentiful in whole grains, fruits and vegetables; reducing high blood pressure; getting regular aerobic exercise and stopping smoking are included in these risk-reduction steps.

Urinary incontinence:

Followed by an involuntary loss of urine (urge incontinence), or the loss of urine with lifting, laughing or coughing (stress incontinence), one may experience a frequent, sudden, strong urge to urinate, because the tissues of the vagina and urethra lose their elasticity.


No medical treatment is required to treat menopause itself. So instead of that, treatments focus on preventing or lessening chronic conditions that may occur with aging, and on relieving the signs and symptoms. These treatments include:


The frequency of hot flashes may be significantly reduced by clonidine, which is a patch or pill typically used to treat high blood pressure; however, unpleasant side effects are common.

Low-dose antidepressants:

Menopausal hot flashes have been shown to decrease because of an antidepressant related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs) which is called venlafaxine. Paroxetine, fluoxetine, sertraline and citalopram are included in other SSRIs that can be helpful.

Hormone therapy:

The most effective treatment option for relieving menopausal hot flashes is definitely estrogen therapy. Estrogen in the lowest dose needed to provide symptom relief for a woman may be recommended depending on her personal and family medical history.


This drug has been shown to significantly reduce hot flashes, and it is approved to treat seizures.

Vaginal estrogen:

Estrogen can be administered locally using a vaginal tablet, ring or cream in order to relieve vaginal dryness. Just a small amount of estrogen is released in this treatment, and is absorbed by the vaginal tissue. Some urinary symptoms, discomfort with intercourse and vaginal dryness can be relieved by this.


To prevent or treat osteoporosis, these nonhormonal medications, which include risedronate, ibandronate and alendronate, may be recommended. Estrogen is replaced as the main treatment for osteoporosis in women, and both the risk of fractures and bone loss are effectively reduced by these medications.

Selective estrogen receptor modulators (SERMs):

A group of drugs that includes raloxifene are SERMs. Without some of the risks associated with estrogen, raloxifene mimics estrogen's beneficial effects on bone density in postmenopausal women.


A woman should talk with her doctor about her options and the benefits and risks involved with each, before deciding on any form of treatment.


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