Menopause classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Rahmah Al-Edresi, M.D.[2]

Overview

Clinically, Menopause does not happen suddenly, but it passes through stages until it reaches the permanent cessation of the menstrual cycle. It is classified as physiological menopause, Premature Menopause/Early menopause, and Induced Menopause.


Classification of Menopause

Physiological Menopause

physiological menopause is amenorrhea without any pathological diseases and medical conditions. As women age, the production of estrogen and progesterone from the ovaries begins to decrease gradually, as these hormones play a major role in the occurrence of menstruation regularly, and as a result of the deficiency of these hormones occurs menopause.

  • Perimenopause or " menopause transition"

Perimenopause means the menopause transition years, the years before and after the last period ever, when the majority of women find that they undergo at least some symptoms of hormonal change and fluctuation, such as hot flashes, mood changes, insomnia, fatigue, irregular menses, etc.

During perimenopause, the production of most of the reproductive hormones, including estrogens and progestin, diminishes and becomes more irregular, often with wide and unpredictable fluctuations in levels. During this period, fertility diminishes.

Symptoms of perimenopause can begin as early as age 35, although most women become aware of them about 10 years later than this. Perimenopause can last for a few years, or ten years or even longer. In this respect, it resembles puberty, a similar process that surrounds menarche. Menopause can usefully be compared to "puberty in reverse", and the psychological adjustments that take place over this period can be compared to adolescence. The actual duration and severity of perimenopause in any individual woman cannot be predicted in advance or during the process.

Not every woman suffers symptoms during perimenopause. Approximately one-third of all women get no noticeable symptoms other than their periods becoming erratic and then stopping. Another one-third of women have moderate symptoms. The remaining one-third of women have very strong symptoms which tend to have a longer duration. The tendency to have very strong perimenopause maybe inherited in some cases.

One piece of recent research appears to show that melatonin supplementation in perimenopausal women can produce a highly significant improvement in thyroid function and gonadotropin levels, as well as restoring fertility and menstruation and preventing the depression associated with the menopause[1].

  • Premenopause

Premenopause is a word used to describe the years leading up to the last period ever when the levels of reproductive hormones are already becoming lower and more erratic, and symptoms of hormone withdrawal may be present.

  • Postmenopause

Postmenopause is all of the time in a woman's life that takes place after her last period ever, or more accurately, all of the time that follows the point when her ovaries become inactive.

A woman is considered in post-menopause after amenorrhea more than 12 months, not even any spotting. When she reaches that point, she is one year into post-menopause. The reason for this delay in declaring a woman post-menopausal is because periods become very erratic at this time of life, and therefore a reasonably long period is necessary to be sure that the cycling has ceased.

In women who have no uterus, and therefore have no periods, post-menopause can be determined by a blood test which can reveal the very high levels of Follicle Stimulating Hormone (FSH) that are typical of post-menopausal women.

A woman's reproductive hormone levels continue to drop and fluctuate for some time into post-menopause, so any hormone withdrawal symptoms that a woman may be experiencing do not necessarily stop right away but may take quite some time, even several years, to disappear completely.

Premature Menopause and Early menopause

Premature menopause is the permanent cessation of the menstrual cycle of the age of 40 because of premature ovarian failure" it is the permanent loss of ovarian function and this condition affects approximately 1% of women". but early menopause is a cessation of the menstrual cycle between 40 and 45 of age.[2]

About 5% of women have early menopause both of them happen because of several medical diseases ( Autoimmune disease, thyroid disease, metabolic disorder, diabetes mellitus).[3]

Induced Menopause

Induced menopause is the permanent cessation of the menstrual cycle because of complication of medical treatment such as chemotherapy, and radiotherapy for treatment of cancer and pelvic surgery such as Bilateral oophorectomy that means remove ovaries which are sometimes done with removal of the Fallopian tubes (salpingo-oophorectomy) so remove ovaries with or without tubes and Hysterectomy that means remove uterus.The causes of menopause after these surgery are the sudden quickly drop in hormone levels after oophorectomy and decrease in the mechanism of feedback after Hysterectomy although ovarian hormones are still produced . The surgical menopause symptoms may be more severe like hot flushes [4]


References

  1. Bellipanni G, DI Marzo F, Blasi F, et al. Effects of melatonin in perimenopausal and menopausal women: our personal experience. 2005. Ann N Y Acad Sci 1057:393-402. DOI: 10.1196/annals.1356.030 PMID 16399909
  2. http://www.menopause.org/docs/default-source/2014/nams-recomm-for-clinical-care.pdf
  3. womenshealth.gov/menopause/early-or-premature-menopause/#2
  4. https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/instant-help-for-induced-menopause


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