Menopause overview

Menopause Microchapters
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Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differential Diagnosis
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Ultrasonography
Other Imaging Findings
Treatment
Medical Therapy
Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Rahmah Al-Edresi, M.D.[2]

Overview

Menopause is the permanent cessation of the menstrual cycle in women without any pathological causes because of physiological deficiency of estrogen hormone production in women.Menopause happens in women between 49 to 52 of age at the average,it is considered a natural end to fertility in women. Menopause is a date: the day after a woman's last period ever finishes. In common everyday parlance, however, the word "menopause" is usually not used to refer to one day, but the whole of the menopause transition years. This period time is also referred to as the change of life or the climacteric, the cessation of menses, and 'climacteric' to gradual changes of ovarian function that happens before the menopause and continue forever. Recently it is known as "perimenopause", (literally meaning "around menopause"). A woman is considered in menopause after amenorrhea for 12 months and she becomes suffering from the menopausal symptoms whose intensity varies from woman to another. 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. Menopause is natural amenorrhea that is happened without any pathological causes, but premature menopause /early menopause caused by pathological diseases, that are lead to early cessation of menses. Menopause occurs naturally or can be induced, Induced menopause happens as a result of bilateral oophorectomy, hysterectomy, salpingo-oophorectomy, a complication of tubal ligation, complications of treatment, such as chemotherapy and radiotherapy, autoimmune diseases such as thyroid disease, rheumatoid arthritis, Turner’s syndrome, myalgic encephalomyelitis/chronic fatigue syndrome, primary ovarian insufficiency Several risk factors accelerate early menopause such as family history and cigarette smoking has been found to decrease the age at menopause by as much as one year and women who smoke have early menopause before non-smoking women. Menopause should be differentiated from other diseases presenting with menstrual irregularities (oligomenorrhea/amenorrhea). Menopause is typically beginning between the ages of 49 and 52, age at menopause is also higher in the West as compared to the range of 45-47 years in developing countries. About 25 million women pass through menopause each year, In the United States, approximately 1.3 million women become menopausal each year. By 2030, the world population of menopausal and postmenopausal women is projected to increase to 1.2 billion. Menopausal symptoms differ in women according to areas and countries that they live them e.g shoulder pain in Japan, hot flush In the West, and low vision in India. 85 % of postmenopausal women have experienced a menopause-related symptom in their lifetime, 15% increased the risk of causes mortality among women at an early age at menopause. The ethnic differences in the symptoms experienced during the menopausal transition were noted. Asian women had experienced the smallest number of menopausal symptoms compared with all other ethnic groups, but African American women had experienced the largest number of menopausal symptoms compared with other ethnic groups.The symptoms of menopause typically develop in the menopausal transition years. Left untreated women, 15% increased the risk of causes mortality among women with menopausal symptoms after approximately 7.4 years on average, women may progress to develop hypertension, atherosclerosis, and hyperlipidemia. Common complications of menopause include Cardiovascular Disease/chronic heart disease, stroke, Osteoporosis. Generally, the prognosis of menopause is good with treatment and a healthy lifestyle include stop smoking, a healthy diet, and exercise. In the late post-menopause stage, most menopausal symptoms relieved in most women. but untreated menopausal symptoms are poor prognosis in women which have high-risk factors to develop of complications that are associated with menopause.The most common symptoms of menopause include hot flashes, night sweats, headach, palpitations, dyspareunia, stress incontinence, urgency, frequency, dysuria, anxiety, sleep disturbance, depression. In addition to some less common symptoms of menopause include loss of concentration, and loss of self confidence. Women with menopause are usually well-appearing. Physical examination of patients with menopause is usually remarkable for elevated blood pressure, weight gain, decrease breast size, pale and dryness of the vagina, decrease ovaries size, decrease uterus size. An elevated serum of Follicle Stimulating Hormone (FSH) greater than 40 mIU/mL is diagnostic of menopause, a decreased serum of the Anti-Mullerian Hormone level(AMH) is a diagnostic test of premature menopause and a low level of AMH is normal in the postmenopause period. a decreased of Estrogen Hormone level in women with menopause.While perimenopause is a natural stage of life when the symptoms are severe, this may be alleviated through medical treatments that include Hormone therapy(HT), non-hormonal therapy, and complementary or alternative therapies.Hormonal therapy (HT) provides the best relief, but hormone therapy should only be used for the shortest duration of time and at its lowest effective dose, as it increases the relative risks of uterine cancer ,ovarian cancer, breast cancer, thromboembolism, and coronary heart disease, especially in women who start HT after menopause. Some other drugs afford limited relief from hot flashes. A woman and her doctor should carefully review her symptoms and relative risk before determining whether the benefits of HT or other therapies outweigh the risks.

Historical Perspective

• Historical perspective of a disease discusses the initial discovery of the disease, the major outbreaks/events associated with the disease, and the initial diagnostic and therapeutic discoveries related to the disease.
• This section should contain the name of the disease you are describing in the first sentence.
• The overview of the historical perspective of a disease should be a short description of the landmark discoveries associated with the disease. It is ideally written after the main historical perspective microchapter is written, to summarize the key points of the microchapter. It can be the same as the overview that is seen on the historical perspective microchapter.
• To view a template and examples of the Historical Perspective overview statement, click here.

Classification

• Classification of a disease varies based on the type of disease. For example, certain cancers may be classified based on stage and grade, whereas a drug allergy may be classified based on the type of drug reaction.
• This section should contain the name of the disease you are describing in the first sentence.
• The overview of the classification of a disease should be a short description of the way in which the disease is classified. It is ideally written after the main classification microchapter is written, to summarize the key points of the microchapter. It can be the same as the overview statement that is seen on the classification microchapter.
• To view a template and examples of the Classification overview statement, click here.

Pathophysiology

• Pathophysiology is the study of the biological and physical manifestations of a disease as they correlate with the underlying abnormalities and physiological disturbances.

• This section should contain the name of the disease you are describing in the first sentence.
• The overview of the pathophysiology of a disease should be a short description of the basic disease process. It is ideally written after the main pathophysiology microchapter is written, to summarize the key points of the microchapter. It can be the same as the overview statement that is seen on the pathophysiology microchapter.
• To view a template and examples of the Pathophysiology overview statement, click here.

Causes

• This section summarizes the main causes of the disease.
• The overview for causes of a disease should ideally be written after the main causes microchapter is written, to summarize the key points of the microchapter. It can be the same as the overview statement found on the main causes microchapter for the disease.
• To view a template and examples of the Causes (Non-microbiology) overview statement, click here.
• To view a template and examples of the Causes (Microbiology) overview statement, click here.

Differentiating (Disease name) from other Conditions

• In this section, give a brief description of the main diseases that need to be differentiated from the disease you are describing.
• The overview of the differentiation of a disease should ideally be written after the main microchapter is written. It can be the same as the overview statement found on the main "differentiating disease from other conditions" microchapter for the disease.
• To view a template and examples of the Differential Diagnosis overview statement, click here.

Epidemiology and Demographics

• Epidemiology is the scientific study of the causes, distribution, and control of disease populations. Demographics are the objective characteristics of a population age, marital status, family size, racial origin, present or prior disease, religion, income, and education and how they relate to a specific disease.
• This section should contain the name of the disease you are describing in the first sentence.
• The overview of the epidemiology and demographics of a disease should ideally be written after the main epidemiology and demographics microchapter is written. It can be the same as the overview statement found on the main epidemiology and demographics microchapter for the disease.
• To view a template and examples of the Epidemiology and Demographics overview statement, click here.

Risk Factors

• Risk factors are variables associated with an increased risk of disease or infection.This section should outline the risk factors that have the highest correlation with the disease.
• The overview of the risk factors of a disease should ideally be written after the main risk factors microchapter is written, to summarize the key points of the microchapter. It can be the same as the overview statement found on the main risk factors microchapter for the disease.
• To view a template and examples of the Risk Factors overview statement, click here.

Natural History, Complications and Prognosis

• The natural history of a disease describes how the disease would progress without treatment. The complications describe the negative consequences of the disease and treatment, and the prognosis describes the outcomes of the disease.
• This section should contain the name of the disease you are describing in the first sentence.
• The overview of the natural history, complications and prognosis is ideally written after the main microchapter is written, to summarize the key points of the microchapter. It can be the same as the overview statement that is seen on the natural history, complications and prognosis microchapter page.
• To view a template and examples of the Natural History, Complications and Prognosis overview statement, click here.

Diagnosis

• The diagnosis of a disease details the most important signs, symptoms, tests, and other studies that lead to the diagnosis of a disease.
• This section should contain the name of the disease you are describing in the first sentence.
• The overview of the diagnosis of a disease should ideally be written after the main diagnosis microchapters are written, to summarize the key points of the microchapters.

History and Symptoms

• Describe the main aspects of the patient history that should be focused on, and the symptoms that lead to, or exclude the diagnosis of the disease you are describing. You should use the name of the disease in the first sentence. For an example of this subsection, click here.
• This section can be the same as the overview section on the history and symptoms page.
• To view a template and examples of the History and Symptoms overview statement, click here.

Physical Examination

• Describe the main physical examination findings that can lead to or exclude the diagnosis of the disease you are describing. You should include the name of the disease in the first sentence. For an example, click here
• This section can be the same as the overview section physical examination page.
• To view a template and examples of the Physical Examination overview statement, click here.

Laboratory Findings

• List the main laboratory studies that can lead to or exclude the diagnosis of the disease you are describing. You should include the name of the disease in the first sentence.
• This section should be the same as the overview statement on the laboratory findings page.
• To view a template and examples of the Laboratory Findings overview statement, click here.

Electrocardiogram

• If EKG findings are pertinent to the diagnosis of the disease you are describing, you can provide the findings here.
• This section can be the same as the overview statement found on the Electrocardiogram page.
• To view a template and examples of the Electocardiogram overview statement, click here.

Chest X Ray

• If chest x ray findings are pertinent to the disease page you are making, you can briefly describe them here.
• This can be the same as the overview statement on the chest x ray page.
• To view a template and examples of the Chest X Ray overview statement, click here.

CT Scan

• If CT findings are pertinent to the page you are making, you can briefly describe them here.
• This section can be the same as the overview section on the CT page.
• To view a template and examples of the CT Scan overview statement, click here.

Echocardiography or Ultrasound

• If echocardiography or ultrasound findings are pertinent to the page you are making, you can describe them here.
• This section can be the same as the overview section on the echocardiography and ultrasound page.
• To view a template and examples of the Echocardiography or Ultrasound overview statement, click here.

Other Imaging Findings

• List the most important diagnostic studies, such as imaging and other studies, that can lead to or exclude the diagnosis of the disease you are describing. You should name any "gold standard" studies here, and include the name of the disease in the first sentence.
• To view a template and examples of the Other Imaging Findings overview statement, click here.

Treatment

• Treatment describes the various, most commonly used methods in treating the disease you are describing.
• This section should contain the name of the disease you are describing in the first sentence.
• The overview of the treatments for a disease should ideally be written after the main treatment microchapter is written, to summarize the key points of the microchapter. It can be the same as the overview statement found on the main risk factors microchapter for the disease.

Medical Therapy

• Medical therapy describes all non-surgical therapies that are provided for the patient.
• This section should contain the name of the disease you are describing in the first sentence followed by the indication to treat the patient (if applicable) and the name of the therapy.
• To view a template and examples of the Medical Therapy overview statement, click here.

Surgery

• Surgery describes all surgeries and therapeutic procedures that are provided for the patient.
• This section should contain the name of the disease you are describing in the first sentence followed by the indication to surgically manage the patient (if application) and the name of the surgery.
• To view a template and examples of the Surgery overview statement, click here.

Prevention

• Prevention describes all strategies that prevent from the occurrence of the disease. Prevention may be either primary (prevent occurrence of the disease), secondary (diagnose and treat existent disease in early stages), tertiary (reduce the negative impact of extant disease), and quaternary (methods to avoid results of unnecessary interventions). At least primary and secondary prevention are usually discussed in each chapter.
• This section should contain the name of the disease you are describing in the first sentence. The availability or lack of vaccine availability of a vaccine against the disease should be clearly written. Other strategies for the prevention of the disease should be outlined and classified as either primary, secondary, tertiary, or quaternary.
• To view a template and examples of the Prevention overview statement, click here.

References

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