• Menoupause is the final menstruation marking the termination of menses (defined as 6 months of amenorrhea)
• Menopause is preceded by the climacteric or perimenioausal period the multiyear transition from optimal menstrual condition to menoupause
• The postmenopause period is the time after menopause

Factors affecting age of onset

Genetics

• Smoking (decreases age by 3 years)
• Chemo / radiation therapy

Physioology during the perimenopausal period

Oocytes die

Women’s immature eggs, or oocytes, begin to die precipitously and become resistant to follicle-stimulating hormone (FSH),  the pituitary hormone that causes their marturation

• FSH levels rise for two reasons :
  1. Decreased inhibin (inhibin inhibits FSH secretion; it is produced smaller amounts by the fewer oocytes)
  2. Resistant oocytes require more FSH to successfully mature, triggering greater FSH release

Ovulation becomes less frequent

Women ovulate less frequently, initially one to two fewer times per year and eventually just before menopause, perhaps once every 3 to 4 months. This is due to shortened follicular phase. The luteal phase does not change.

Estrogen levels fall

Estrogen levels begin to decline, resulting in hot flashes (may also be due to increased luteinizing hormone) Hot flashes usually occur on the face, neck and upper chest and last a few minutes followed by intense diaphoresis.

Physiology during the menopausal period

Levels of androstenedione fall, a hormone that is primarily produced by the follicle.

• Ovaries increase production of testosterone which may result in hirsutism and virilism
• Decrease in estradiol level and decrease in estrone level
• FSH and LH levels rise secondary to absenece of negative feedback.

Treatment of the adverse effects of menopause

Hormone replacement therapy or estrogen replacement therapy has been shown to counteract the complications of estradiol loss.

Estrogen replacement therapy

Indicated in women status post hysterectomy.

Hormone replacement therapy

The progesterone component is needed to protect the endometrium for constant stimulation and resultant increase in endometrial cancer. It is indicated for women who still have their uterus.

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