Menopause overview

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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

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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. 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

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.

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.

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.

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.

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