Relevant studies were identified from comprehensive searches of MedLine (1966 to December, 2006) and the Cochrane database of systematic reviews and controlled trials (last accessed December, 2006). Search strategies focused on menopausal symptoms and therapies for symptoms using the terms climacteric and menopause with terms depression, depressive disorder, affect, mood disorders, quality of life, sex disorders or dysfunction, sleep disorder, urination disorder, vasomotor symptom,
SeminarMenopause
Introduction
The transition to menopause is a complex physiological process, often accompanied by the additional effects of ageing and social adjustment. Historically, much medical knowledge of menopause drew on convention rather than on rigorously designed studies, which led to inappropriate care. Moreover, at times serious symptoms were regarded as normal concomitants of the time of life and not addressed further, and mild symptoms were overmedicalised.
Menopause results from reduced secretion of the ovarian hormones oestrogen and progesterone, which takes place as the finite store of ovarian follicles is depleted. Natural menopause is diagnosed after 12 months of amenorrhoea not associated with a pathological cause. Menopause can also be induced by surgery, chemotherapy, or radiation. Initially, the menstrual cycle lengths become irregular, and follicle-stimulating hormone (FSH) concentrations rise in response to decreased concentrations of ovarian hormones. As the menopausal transition progresses, menstrual cycles are missed and ultimately stop, as does ovulation. For some women, 3 consecutive months of amenorrhoea, or mean cycle lengths longer than 42 days, are predictors of impending menopause.2, 3
Several terms have been used to describe the events that take place during the menopausal transition. A model developed at the Stages of Reproductive Aging Workshop (STRAW)4 described seven stages of reproductive ageing (figure 1), which were subdivided into reproductive stages, characterised by regular menstrual cycles; menopausal transition stages, with variable menstrual cycles and high FSH values; and postmenopause stages, beginning with the final menstrual period, and lasting until the end of life. Definitions and models continue to be assessed and refined for clinical and research applications.5, 6, 7 Although models are useful to describe the general progression of events leading to menopause, substantial individual variation exists, including skipping stages and moving back and forth between stages.8
The menopausal transition usually begins when women are in their mid-to-late 40s, and can last several years, most commonly 4–5 years.9 The final menstrual period generally happens when women are between 40 and 58 years old,9 and a final menstrual period before 40 years of age is regarded as premature. Population studies suggest that smoking and low socioeconomic status are associated with premature final menstrual periods.10 Other factors can affect the age at which women have their final menstrual period, including age at menarche, parity, previous oral contraceptive use, body-mass index, ethnic origin, and family history.11 The age at which women have their final menstrual period varies across large surveys done in different countries. Mean ages of 50–51 years were reported in Italy, Iran, Slovenia,11 and the USA;12 and of 47–50 years in Korea, Lebanon, Singapore, Greece, Morocco, Mexico, Taiwan, and Turkey.11
Section snippets
Clinical manifestations
Many clinical manifestations have been attributed to menopause. Vasomotor episodes manifest as spontaneous sensations of warmth, usually felt on the chest, neck and face, and often associated with perspiration, palpitations, and anxiety. These episodes are described as hot flushes, hot flashes, and night sweats. The term “hot flush” indicates the sensation of heat; “hot flash” describes episodes with sweating, sometimes followed by a chill; however, the terms are often used interchangeably.
Management and treatment
Many questions about the menopausal transition and its effects on health have not yet been adequately answered. Considerable differences exist between individuals from different countries. Even in homogeneous populations, individual experiences of menopause vary, as do experiences of pregnancy. The best possible approach to the management of menopausal symptoms is to address each woman's unique needs.
Surveys in the USA indicate that physicians underestimate their patients' concerns about
Conclusions
Menopause is an expected life event for midlife women. Most women have transient symptoms that are manageable with self-care approaches, such as wearing layers of clothing, and lowering stress. Some women ask health providers for help to manage menopausal symptoms, especially frequent and severe vasomotor symptoms and vaginal dryness, that interfere with healthy living. Coexistent health concerns can complicate the presentation, and require independent assessment. Social changes that are common
Search strategy and selection criteria
References (126)
- et al.
Staging the menopausal transition: data from the TREMIN Research Program on Women's Health
Womens Health Issues
(2004) - et al.
Reduced thermoregulatory null zone in postmenopausal women with hot flashes
Am J Obstet Gynecol
(1999) - et al.
A universal menopausal syndrome?
Am J Med
(2005) A factor analytic study of climacteric symptoms
J Psychosom Res
(1976)- et al.
A menopause-specific quality of life questionnaire: development and psychometric properties
Maturitas
(1996) - et al.
Change in psychological and vasomotor symptom reporting during the menopause
Soc Sci Med
(2002) - et al.
A prospective population-based study of menopausal symptoms
Obstet Gynecol
(2000) - et al.
The Manitoba Project: a re-examination of the link between menopause and depression
Maturitas
(1992) - et al.
A longitudinal analysis of the association between menopause and depression. Results from the Massachusetts Women's Health Study
Ann Epidemiol
(1994) - et al.
Symptom experiences of midlife women: observations from the Seattle Midlife Women's Health Study
Maturitas
(1996)