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Latest revision as of 14:08, 2 March 2021

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. A woman is considered in menopause after amenorrhea for 12 months and she becomes suffering from the menopausal symptoms. Menopause is passes gradually through 3 stages until it reaches the permanent cessation of the menstrual cycle. These stages include premenopause, Perimenopause, and postmenopause. Premenopause is a word used to describe the years leading up to the last period even when the levels of reproductive hormones are already becoming lower and more erratic, and symptoms of hormone withdrawal may be present. Perimenopause or "menopause transition" 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. Postmenopause, a woman has considered in post-menopause after amenorrhea more than 12 months. 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). The prevalence of menopause is estimated to be about 50 million cases worldwide annually. The common symptoms of menopause include hot flashes, night sweats, headach, palpitation, dyspareunia, stress incontinence, urgency, frequency, dysuria, anxiety, sleep disturbance, depression. Left untreated women, increased the risk of hypertension, atherosclerosis, and hyperlipidemia. Common complications of menopause include cardiovascular disease, stroke, osteoporosis. Generally, the prognosis of menopause is good with treatment and a healthy lifestyle include stop smoking, a healthy diet, and exercise. An elevated serum of Follicle Stimulating Hormone (FSH) greater than 40 mIU/mL is diagnostic of menopause. Medical treatments of severe menopausal symptoms include Hormone therapy(HT), non-hormonal therapy, and complementary or alternative therapies. Hormonal therapy (HT) provides the best relief, but 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. 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

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 medull a 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.

Differential Diagnosis

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

There are several risk factors that accelerate menopause onset. Common risk factors include women's age, age at menarche, age at first gestation, number of pregnancies, oral contraceptives, irregular menses, unilateral oophorectomy, body mass index, smoking, tobacco, and alcohol, high physical activity, high serum lead level, high intake of fat.

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.

Diagnosis

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 below 0.20 ng/ml. 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.

Ultrasonography

On pelvic ultrasound, menopause is characterized by small uterus and an endometrial thickness between 5-8 mm. Small ovaries with either a few follicles or no, and normal or non-visible adnexa. Transvaginal ultrasound is helpful for intitial evaluation of postmenopausal bleeding women, if endometrial thickness is 4mm or less, women more prone able for endometrial cancer. Endometrial biopsy is indicated in recurrent postmenopausal bleeding cases.

Treatment

Medical Therapy

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 a short duration and the lowest effective dose, as it increases the relative risk 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.

Prevention

Menopause is not preventable. Early menopause are preventable with the following strategie such as stop smoking, healthy food, regular exercies. Secondary prevention of menopause include HRT, followup of associated medical diseases and postmenopausal bleeding. Early determination of these conditions is very important in terms of morbidity/mortality and cost of the treatment.

Coast-Effectiveness of Therapy

Given the morbidity associated with menopause, and the high cost of HRT and non- hormonal therapy, current pharmacotherapy to treat menopause are cost-effective.

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 ==Overview==
-[[Menopause]] is the permanent cessation of the [[Menstrual cycles|menstrual cycle]] in [[women]] without any [[pathological]] causes because of [[Physiological|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 [https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397 menopausal symptoms]
+[[Menopause]] is the permanent cessation of the [[Menstrual cycles|menstrual cycle]] in [[women]] without any [[pathological]] causes because of [[Physiological|physiological deficiency]] of [[Estrogen|estrogen hormone]] production in [[women]]. [[Menopause]] happens in [[women]] between 49 to 52 of age at the average. A woman is considered in [[menopause]] after [[amenorrhea]] for 12 months and she becomes suffering from the [https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397 menopausal symptoms]. M[[menopause|enopause]] is passes gradually through 3 stages until it reaches the permanent cessation of the [[menstrual cycle]]. These stages include [[Perimenopause|premenopause]], [[Perimenopause]], and [[Menopause|postmenopause]]. [[Perimenopause|Premenopause]] is a word used to describe the years leading up to the last [[period]] even when the levels of [https://www.cancer.gov/publications/dictionaries/cancer-terms/def/reproductive-hormone reproductive hormones] are already becoming lower and more erratic, and [[symptoms]] of [https://pubmed.ncbi.nlm.nih.gov/23421366/ hormone withdrawal] may be present. [[Perimenopause]] or "[[menopause]] transition" 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. [[Menopause|Postmenopause]], a [[Women|woman]] has considered in [[Menopause|post-menopause]] after [[amenorrhea]] more than 12 months. Several [[risk factors]] accelerate [https://www.healthline.com/health/menopause/causes-early 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 [https://www.healthline.com/health/menopause/causes-early early menopause] before [[non-smoking]] women. [[Menopause]] should be differentiated from other [[diseases]] presenting with [[menstrual irregularities]] ([[oligomenorrhea]]/[[amenorrhea]]). The [[prevalence]] of [[menopause]] is estimated to be about 50 million cases worldwide annually. The common [[symptoms]] of [[menopause]] include [[hot flashes]], [[night sweats]], [[Headache|headach]], [[palpitation]], [[dyspareunia]], [[stress incontinence]], [[urgency]], [[frequency]], [[dysuria]], [[anxiety]], [[sleep disturbance]], [[depression]]. Left untreated women, increased the risk of  [[hypertension]], [[atherosclerosis]], and [[hyperlipidemia]]. Common [[complications]] of [[menopause]] include [[cardiovascular disease]], [[stroke]], [[osteoporosis]]. Generally, the [[prognosis]] of [[menopause]] is good with [[treatment]] and a healthy lifestyle include stop [[smoking]], a healthy diet, and [[exercise]].   An elevated [[serum]] of [[Follicle-stimulating hormone|Follicle Stimulating Hormone]] ([[FSH]]) greater than 40 mIU/mL is [[diagnostic]] of [[menopause]].  [[Medical treatment|Medical treatments]] of severe [https://www.healthline.com/health/menopause menopausal symptoms] include [[Hormone therapy]](HT), non-hormonal therapy, and [[complementary]] or [[Alternative therapies for developmental and learning disabilities|alternative therapies]]. [[Hormone therapy|Hormonal therapy]] (HT) provides the best relief, but it increases the relative risks of [[uterine cancer]], [[ovarian cancer]], [[breast cancer]], [[thromboembolism]], and [[coronary heart disease]], especially in women who start [[Hormonal replacement therapy|HT]] after [[menopause]]. A woman and her doctor should carefully review her [[Symptom|symptoms]] and relative risk before determining whether the benefits of [[Hormone replacement therapy|HT]] or other [[Therapy|therapies]] outweigh the risks.
 ==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 the past, the studies on cessation of the [[menstrual cycle]] after 40 years of age in [[women]] were very rare, a French [[physician]] named the cessation of the [[menstrual cycle]] as a term of [[menopause]] in 1821. The [[medical]] interest in [[menopause]] started in the mid-19th century and therefore knew the [https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397 menopause symptoms], and was treated by [[estrogen replacement therapy]] in the 1970s and had been developed in 1938. The Grandmother [[hypothesis]] considers that [[menopause]] may have been selected for in [[human]] evolution. Unlike [[humans]], other [[mammals]] rarely experience [[menopause]], but it does exist in 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|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]].
-Clinically, [[Menopause]] does not happen suddenly, but it passes through stages until it reaches the permanent cessation of the [[menstrual cycle]]. It is classified according to [[pathological]] causes into three types including [[physiological]] [[menopause]], [[Premature Menopause]]/Early [[menopause]], and Induced [[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. [[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, but early [[menopause]] is a cessation of the [[menstrual cycle]] between 40 and 45 of age, and both of them happen because of several [[medical]] [[diseases]] as ( [[Autoimmune disease]], [[Thyroid disease]], [[Metabolic disorder]], [[Diabetes mellitus]]). Induced [[menopause]] is the permanent cessation of the [[menstrual cycle]] because of [[Complication (medicine)|complication]] of [[medical treatment]] such as [[Chemotherapy]], and [[Radiotherapy]].
 ==Pathophysiology==
-[[Menopause]] is natural [[amenorrhea]] that is happened without any [[pathological]] causes, but [[premature menopause]]/early [[menopause]] caused by [[pathological]] [[diseases]] in [[ovaries]] include [[premature ovarian failure]] termed as [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2762081/ Primary ovarian insufficiency] ([https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2762081/ POI]), several [[medical condition]] such as [[Adrenal insufficiency]], type1 [[Diabetes mellitus]], [[Autoimmune thyroid diseases|Autoimmune thyroid disease]], [[Fragile X syndrome|Fragile X Syndrome]], [[Fanconi’s anemia]], [[Congenital adrenal hyperplasia]], and [https://www.mayoclinic.org/diseases-conditions/turner-syndrome/symptoms-causes/syc-20360782#:~:text=Overview,to%20develop%20and%20heart%20defects. Turner’s syndrome]. The most important Conditions associated with [[Menopause]] are [[Cardiovascular diseases|Cardiovascular disease]] and [[Osteoporosis]]. Under microscope the structures of the [[ovaries]] are change, The [[Cortex (anatomy)|cortex]] becomes thinner and it has fewer follicles, the [[medulla]] develops [[stromal]] [[fibrosis]] and scars. The [[mucosa]] layer of the [[vagina]] begins to [[atrophy]] due to decreased [[estrogen]].
+[[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==
-Common [[causes]] of [[menopause]] include of [[age]], certain [[medical condition]] include [[Autoimmune diseases]], [[Diabetes mellitus|Diabetes Mellitus]],[[Thyroid disease]], [[complications]] of [[chemotherapy]] and [[radiotherapy]], and [[Surgery|surgical]] [[causes]] include bilateral [[oophorectomy]], [[hysterectomy]], [[salpingo-oophorectomy]], and [[Complication (medicine)|complication]] of [[tubal ligation]]. Less common [[causes]] include [[chronic fatigue syndrome]] and [[HIV]]. [[Genetics|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].
+[[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==
-[[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]].
+==Differential Diagnosis==
+[[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==
-The [[prevalence]] of [[menopause]] is estimated to be about 25 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]].
+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==
+There are several [[risk factors]] that accelerate [[menopause]] onset. Common [[risk factors]] include women's age, age at [[menarche]], age at first [[gestation]], number of [[pregnancies]], [[Oral contraceptive|oral contraceptives]], [https://www.medicalnewstoday.com/articles/322643#:~:text=Your%20period%20is%20considered%20irregular,possible%20causes%20and%20their%20symptoms. irregular menses], [[Oophorectomy|unilateral oophorectomy]], [[body mass index]], [[smoking]], [[tobacco]], and [[alcohol]], high [[physical activity]], high [[Blood lead level|serum lead level]], high intake of [[fat]].
-*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 [[Risk factor template#Overview|'''here''']].
 ==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]].
-*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 [[Natural history, complications and prognosis template#Overview|'''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===
+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.
-*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 [[Myocarditis overview#Diagnosis|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 [[History and symptoms template#Overview|'''here''']].
 ===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].
-*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 [[Pericarditis overview#Diagnosis|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 [[Physical examination template#Overview|'''here''']].
 ===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 below 0.20 ng/ml. 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]].
-*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.
+===Ultrasonography===
-*This section should be the same as the overview statement on the laboratory findings page.
+On [[pelvic ultrasound]], [[menopause]] is characterized by small [[uterus]] and an [[Endometrium|endometrial]] thickness between 5-8 mm. Small [[ovaries]] with either a few [[Follicle|follicles]] or no, and normal or non-visible [[adnexa]]. [[Transvaginal ultrasound]] is helpful for intitial evaluation of [[postmenopausal bleeding]] women, if [[endometrial]] thickness is 4mm or less, women more prone able for [[endometrial cancer]]. [[Endometrial biopsy]] is indicated in recurrent [[postmenopausal bleeding]] cases.
-*To view a template and examples of the Laboratory Findings overview statement, click [[Laboratory findings template#Overview|'''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 [[Electrocardiogram template#Overview|'''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 [[Chest x ray template#Overview|'''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 [[CT template#Overview|'''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 [[Echocardiography or ultrasound template#Overview|'''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 [[CT template#Overview|'''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===
+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 medicine|alternative]] therapies.[[ Hormonal therapy]] (HT) provides the best relief, but [[hormone therapy]] should only be used for a short duration  and the lowest [[effective dose]], as it increases the [[relative risk]] of [[uterine cancer]], [[ovarian cancer]], [[breast cancer]], [[thromboembolism]], and [[coronary heart disease]], especially in [[women]] who start [[Hormone replacement therapy|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 [[Hormone Replacement Therapy|HT]] or other [[Medicine|therapies]] outweigh the [[risks]].
+===Prevention===
+[[Menopause]] is not preventable. [https://www.healthline.com/health/menopause/causes-early Early menopause] are preventable with the following strategie such as stop [[smoking]], healthy food, regular exercies. [[Secondary prevention]] of [[menopause]] include [[HRT]], followup of associated medical diseases and [[postmenopausal bleeding]]. Early determination of these conditions is very important in terms of [[Morbidity & Mortality|morbidity/mortality]] and cost of the [[treatment]].
+===Coast-Effectiveness of Therapy===
+Given the [[morbidity]] associated with [[menopause]], and the high cost of  [[HRT]] and [https://www.health.harvard.edu/menopause/nonhormonal-treatments-for-menopause non- hormonal therapy], current [[pharmacotherapy]] to [[Treatment|treat]] [[menopause]] are [[Cost-effectiveness|cost-effective]].
-*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 [[Medical therapy template#Overview|'''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 [[Surgery template#Overview|'''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 [[Prevention template#Overview|'''here''']].
-==References==
 [[Category:Help]]