Menopause

Menopause is the time when menstrual periods permanently stop, marking the end of the reproductive phase for female humans. The menopausal transition can be divided into three stages: perimenopause, menopause, and postmenopause. Menopause is a natural part of aging, it can also be a result of surgery, or have another medical or non-medical source. Natural menopause is the result of a decrease in the production of the hormones estrogen and progesterone. Natural menopause typically occurs between the ages of 45 and 55, although the exact timing can vary occurring earlier or later for a variety of reasons, for example tobacco use may result in an earlier menopause while having been pregnant may result in a later menopause. Surgical menopause occurs as the result of a surgery that removes both ovaries. Surgical removal of the ovaries or ovarian failure before the age of 40 years is termed "premature ovarian insufficiency". A marked decrease in hormone levels can have other sources, including some types of chemotherapy. Women often notice symptoms of hormonal changes prior to any formal diagnosis, tests which measure hormone levels in blood or urine can confirm menopause.
In the years before menopause, a woman's periods typically become irregular, which means that periods may be longer or shorter in duration, or be lighter or heavier in the amount of flow. During this time, women often experience hot flashes; these typically last from 30 seconds to ten minutes and may be associated with shivering, night sweats, and reddening of the skin. Hot flashes can recur for four to five years. Other symptoms may include vaginal dryness, urinary frequency and urgency, trouble sleeping, and mood changes. The severity of symptoms varies between women. Menopause is also known to cause thinning and drying of the skin as 30% of the skin's collagen is lost during the first five years of menopause.
In addition to symptoms (hot flushes/flashes, night sweats, mood changes, arthralgia and vaginal dryness), the physical consequences of menopause include bone loss, increased central abdominal fat, and adverse changes in a woman's cholesterol profile and vascular function. These changes predispose postmenopausal women to increased risks of osteoporosis and bone fracture, and of cardio-metabolic disease (diabetes and cardiovascular disease).
Medical professionals often define menopause as having occurred when a woman has not had any menstrual bleeding for a year. It may also be defined by a decrease in hormone production by the ovaries. In those who have had surgery to remove their uterus but still have functioning ovaries, menopause is not considered to have yet occurred. Following the removal of the uterus, symptoms of menopause typically occur earlier. Iatrogenic menopause occurs when both ovaries are surgically removed (oophorectomy) along with the uterus for medical reasons. A survey in 2023 found that less than one-third of the obstetrics and gynecology resident programs offer standardized menopause curriculum, leading to incorrect diagnosis and referrals to specialists for individual symptoms rather than offering treatment for the underlying menopausal source of the symptoms.
Medical treatment of menopause, including hormonal and non-hormonal therapies are used in the treatment of menopause. Complimentary medicine and alternative medicine therapies are also used for symptom management. Medical treatment includes Menopausal hormone therapy(MHT) as well as non-hormonal therapies. MHT is an effective medical treatment used both to ameliorate symptoms, such as: hot flashes, neurocognitive impairments, joint pain and vaginal dryness, and to prevent bone loss and changes to metabolism, blood vessels, and the heart, that can result from the menopausal transition.Many of the concerns about the use of MHT raised by older studies are no longer considered barriers to MHT in healthy women. In some cases non-hormonal therapies are needed or preferred. Non-hormonal therapies for hot flashes include cognitive-behavioral therapy, clinical hypnosis, gabapentin, and fezolinetant or selective serotonin reuptake inhibitors. Neurocognitive symptoms of menopause can be treated with lisdexamfetamine. Mild symptoms may be improved with lifestyle changes. With respect to hot flashes, avoiding nicotine, caffeine, and alcohol is often recommended; sleeping naked in a cool room and using a fan may help. Exercise may help with sleep disturbances. As of 2021, scientists had found little evidence for the effectiveness of supplements and herbal remedies, however research in ongoing.