Menopause overview: Difference between revisions
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==Historical Perspective== | ==Historical Perspective== | ||
In 1821, a French [[physician]] named the cessation of the [[menstrual cycle]] as a term of [[menopause]].The medical interest in [[menopause]] started in the mid-19th century, and was treated by [[estrogen replacement therapy]] in the 1970s. The Grandmother [[hypothesis]] considers that the [[menopause]] may have been selected for in [[human]] evolution. Unlike [[humans]], other [[mammals]] rarely experience [[menopause]], but some of the other few [[Mammals|mammal]] [[species]] that experience [[menstrual cycles]], such as rhesus monkeys and some cetaceans. | |||
In | |||
==Classification== | ==Classification== | ||
[[Menopause]] is classified according to [[causes]] into three types including natural [[menopause]], [[Premature Menopause|premature menopause]]/[https://www.healthline.com/health/menopause/causes-early early menopause], and [https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/instant-help-for-induced-menopause induced menopause]. Natural [[menopause]], does not happen suddenly, but it passes through 3 stages include [[perimenopause]], [[Perimenopause|premenopause]], and [[Menopause|postmenopause]]. [[Premature menopause]] because of [[premature ovarian failure]] and several medical [[diseases]]. [https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/instant-help-for-induced-menopause Induced menopause] because of bilateral [[oophorectomy]], [[salpingo-oophorectomy]], and [[hysterectomy]]. in addition to [[Complication (medicine)|complication]] of [[chemotherapy]] and [[radiotherapy]]. | |||
==Pathophysiology== | ==Pathophysiology== | ||
[[Menopause]] is natural [[amenorrhea]] that is happened without any [[pathological]] causes, but [[premature menopause]]/early | [[Menopause]] is natural [[amenorrhea]] that is happened without any [[pathological]] causes, but [[premature menopause]]/[https://www.healthline.com/health/menopause/causes-early early menopause] is caused by [[pathological]] [[diseases]] in [[ovaries]] and other [[organs]] such as [[premature ovarian failure]] ([https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2762081/ Primary ovarian insufficiency, POI)], [[Adrenal insufficiency]], type1 [[diabetes mellitus]], [[Autoimmune thyroid diseases|autoimmune thyroid disease]], [[Fanconi anemia|Fanconi’s anemia]], and [[Congenital adrenal hyperplasia]]. [[Cardiovascular disease]] and [[Osteoporosis|osteoporosis]] are most important [[conditions]] associated with [[menopause]]. [[Women]] who had [[genetic disorders]] ( [[Fragile X syndrome]], [https://www.mayoclinic.org/diseases-conditions/turner-syndrome/symptoms-causes/syc-20360782#:~:text=Overview,to%20develop%20and%20heart%20defects. Turner’s syndrome]) more prone able to [https://www.healthline.com/health/menopause/causes-early early menopause]. The [[histopathological]] analysis include [[ovaries]]'s [[cortex]] becomes thinner and it has fewer [[Follicle|follicles]] and the [[medulla|medull]][[medulla|a]] develops [[fibrosis]] and [[scars]]. Decrease of [[ciliated]] [[cells]] of [[Fallopian tubes]] and [[Uterus]]. And [[atrophy]] of [[Vagina|vaginal mucosal layer]] . | ||
==Causes== | ==Causes== | ||
[[menopause]] is caused by the increased [[age]] of [[women]]. But the common [[causes]] of [[premature menopause]] include [[Premature ovarian failure]], [[chemotherapy]], and [[radiotherapy]] and bilateral [[oophorectomy]], [[salpingo-oophorectomy]], and [[hysterectomy]]. Less common [[causes]] include [[Autoimmune diseases]], [[Diabetes mellitus|diabetes mellitus]], [[Thyroid disease]]. [[chronic fatigue syndrome]]. [[Genetic disorder|Genetic]] causes include [[Fragile X syndrome|Fragile X Syndrome]] and [https://www.mayoclinic.org/diseases-conditions/turner-syndrome/symptoms-causes/syc-20360782#:~:text=Overview,to%20develop%20and%20heart%20defects. Turner’s syndrome] . | |||
==Differentiating menopause from other Conditions== | ==Differentiating menopause from other Conditions== | ||
[[Menopause]] should be differentiated from other [[diseases]] presenting with [[menstrual irregularities]] ([[oligomenorrhea]]/[[amenorrhea]]) that are include [[Sheehan's syndrome]], [[Lymphocytic hypophysitis]], [[Pituitary apoplexy]], [[Empty sella syndrome]], [[Pituitary]] [[cachexia]], [[Primary hypothyroidism|Hypothyroidism]], [[Hypogonadotropic hypogonadism]],Hypoprolactinemia, [[Primary adrenal insufficiency]]/[[Addison's disease]]. | [[Menopause]] should be differentiated from other [[diseases]] presenting with [[menstrual irregularities]] ([[oligomenorrhea]]/[[amenorrhea]]) that are include [[Sheehan's syndrome]], [[Lymphocytic hypophysitis]], [[Pituitary apoplexy]], [[Empty sella syndrome]], [[Pituitary]] [[cachexia]], [[Primary hypothyroidism|Hypothyroidism]], [[Hypogonadotropic hypogonadism]], [[Prolactin|Hypoprolactinemia]], [[Primary adrenal insufficiency]]/[[Addison's disease]]. | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
The [[prevalence]] of [[menopause]] is estimated to be about | The [[prevalence]] of [[menopause]] is estimated to be about 50 million cases annually. [[Menopause]] naturally occurs in [[women]] between 49 to 52 of [[age]] the [[average]]. The [[Fatality rate|fatality]] cases were 345 cases per 3191 [[women]] aged between 50-86 years in the [[United States]]. There is no [[racial]] predilection to [[Menopause]], but African American [[women]] had experienced the largest number of [https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397 menopausal symptoms] compared with other [[Ethnic group|ethnic groups]]. | ||
==Risk Factors== | ==Risk Factors== | ||
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==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
If left untreated, [[women]] with [[menopause]] may progress to develop [[hypertension]], [[hyperlipidemia]], and [[atherosclerosis]]. Common [[complications]] of [[menopause]] include[[cardiovascular disease]], [[osteoporosis]], [[Stroke]]. The [[Complications|complication]] that is happened with [[Hormone replacement therapy|hormonal replacement therapy]] includes [[ovarian cancer]], [[breast cancer]], and [[endometrial cancer]]. Generally, the [[prognosis]] of [[menopause]] is good with [[treatment]] and a [[healthy]] lifestyle. In the late [[Postmenopausal|postmenopause]] stage, most [https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397 menopausal symptoms] relieved in most [[women]]. but untreated [https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397 menopausal symptoms] are poor [[prognosis]] in [[women]] who have high-[[risk factors]] to develop [[complications]] of [[menopause]]. | |||
===History and Symptoms=== | ===History and Symptoms=== | ||
The hallmark of [[menopause]] is [[amenorrhea]]. The most common [[symptoms]] of [[menopause]] include [[hot flashes]], [[night sweats]], [[Headache|headach]], [[palpitations]], [[dyspareunia]], [[stress incontinence]], [[urgency]], [[frequency]], [[dysuria]], [[Anxiety Disorder|anxiety]], [[sleep disturbance]], [[depression]]. Less common [[symptoms]] of [[menopause]] include loss of [[Concentrations|concentration]], and loss of self confidence. | |||
===Physical Examination=== | ===Physical Examination=== | ||
[[Women]] with [[menopause]] are usually well-appearing. Common [[physical examination]] of [[women]] with [[menopause]] include [[elevated blood pressure]], [[hot flushes]], [[weight gain]], change of [[breast]] size, [[Vaginal|vaginal atrophy]], [https://www.merckmanuals.com/home/women-s-health-issues/biology-of-the-female-reproductive-system/female-external-genital-organs#:~:text=The%20external%20genital%20organs%20include,sperm%20to%20enter%20the%20body external genital organs] become thinner. In premature menopause, [https://www.mayoclinic.org/diseases-conditions/turner-syndrome/symptoms-causes/syc-20360782 Signs of Turner syndrome], and [https://www.nichd.nih.gov/health/topics/fragilex/conditioninfo/commonsymptoms Signs of Fragil X syndrome]. | |||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
[[Laboratory]] findings consistent with the [[diagnosis]] of [[menopause]] include an elevated [[Follicle Stimulating Hormone]] > 40 mIU/mL, decreased [[estradiol]] [[Estrogen|l]]<nowiki/>evel <20 pg/ml, and decreased [[serum]] of the [https://rmanetwork.com/blog/anti-mullerian-hormone-amh-testing-of-ovarian-reserve/#:~:text=Maguire%3A%20AMH%2C%20or%20Anti%2D,a%20woman's%20overall%20egg%20count. Anti-Mullerian Hormone] level. In addition to other [[blood tests]] that are related to [[premature menopause]] such as positive [[karyotype]] test of [[FMR1]] in [[Fragile X syndrome]] and decrease of [[Thyroid-stimulating hormone]]. | |||
===Electrocardiogram=== | ===Electrocardiogram=== | ||
Revision as of 05:26, 17 February 2021
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Menopause Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Menopause overview On the Web |
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American Roentgen Ray Society Images of Menopause overview |
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. 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
Historical Perspective
In 1821, a French physician named the cessation of the menstrual cycle as a term of menopause.The medical interest in menopause started in the mid-19th century, and was treated by estrogen replacement therapy in the 1970s. The Grandmother hypothesis considers that the menopause may have been selected for in human evolution. Unlike humans, other mammals rarely experience menopause, but some of the other few mammal species that experience menstrual cycles, such as rhesus monkeys and some cetaceans.
Classification
Menopause is classified according to causes into three types including natural menopause, premature menopause/early menopause, and induced menopause. Natural menopause, does not happen suddenly, but it passes through 3 stages include perimenopause, premenopause, and postmenopause. Premature menopause because of premature ovarian failure and several medical diseases. Induced menopause because of bilateral oophorectomy, salpingo-oophorectomy, and hysterectomy. in addition to complication of chemotherapy and radiotherapy.
Pathophysiology
Menopause is natural amenorrhea that is happened without any pathological causes, but premature menopause/early menopause is caused by pathological diseases in ovaries and other organs such as premature ovarian failure (Primary ovarian insufficiency, POI), Adrenal insufficiency, type1 diabetes mellitus, autoimmune thyroid disease, Fanconi’s anemia, and Congenital adrenal hyperplasia. Cardiovascular disease and osteoporosis are most important conditions associated with menopause. Women who had genetic disorders ( Fragile X syndrome, Turner’s syndrome) more prone able to early menopause. The histopathological analysis include ovaries's cortex becomes thinner and it has fewer follicles and the medulla develops fibrosis and scars. Decrease of ciliated cells of Fallopian tubes and Uterus. And atrophy of vaginal mucosal layer .
Causes
menopause is caused by the increased age of women. But the common causes of premature menopause include Premature ovarian failure, chemotherapy, and radiotherapy and bilateral oophorectomy, salpingo-oophorectomy, and hysterectomy. Less common causes include Autoimmune diseases, diabetes mellitus, Thyroid disease. chronic fatigue syndrome. Genetic causes include Fragile X Syndrome and Turner’s syndrome .
Differentiating menopause from other Conditions
Menopause should be differentiated from other diseases presenting with menstrual irregularities (oligomenorrhea/amenorrhea) that are include Sheehan's syndrome, Lymphocytic hypophysitis, Pituitary apoplexy, Empty sella syndrome, Pituitary cachexia, Hypothyroidism, Hypogonadotropic hypogonadism, Hypoprolactinemia, Primary adrenal insufficiency/Addison's disease.
Epidemiology and Demographics
The prevalence of menopause is estimated to be about 50 million cases annually. Menopause naturally occurs in women between 49 to 52 of age the average. The fatality cases were 345 cases per 3191 women aged between 50-86 years in the United States. There is no racial predilection to Menopause, but African American women had experienced the largest number of menopausal symptoms compared with other ethnic groups.
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
If left untreated, women with menopause may progress to develop hypertension, hyperlipidemia, and atherosclerosis. Common complications of menopause includecardiovascular disease, osteoporosis, Stroke. The complication that is happened with hormonal replacement therapy includes ovarian cancer, breast cancer, and endometrial cancer. Generally, the prognosis of menopause is good with treatment and a healthy lifestyle. In the late postmenopause stage, most menopausal symptoms relieved in most women. but untreated menopausal symptoms are poor prognosis in women who have high-risk factors to develop complications of menopause.
History and Symptoms
The hallmark of menopause is amenorrhea. The most common symptoms of menopause include hot flashes, night sweats, headach, palpitations, dyspareunia, stress incontinence, urgency, frequency, dysuria, anxiety, sleep disturbance, depression. Less common symptoms of menopause include loss of concentration, and loss of self confidence.
Physical Examination
Women with menopause are usually well-appearing. Common physical examination of women with menopause include elevated blood pressure, hot flushes, weight gain, change of breast size, vaginal atrophy, external genital organs become thinner. In premature menopause, Signs of Turner syndrome, and Signs of Fragil X syndrome.
Laboratory Findings
Laboratory findings consistent with the diagnosis of menopause include an elevated Follicle Stimulating Hormone > 40 mIU/mL, decreased estradiol level <20 pg/ml, and decreased serum of the Anti-Mullerian Hormone level. In addition to other blood tests that are related to premature menopause such as positive karyotype test of FMR1 in Fragile X syndrome and decrease of Thyroid-stimulating hormone.
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.