Menopause

Menopause
Other names	Climacteric
Specialty	Gynecology
Symptoms	No menstrual periods for a year[1]
Duration	~3 years
Causes	Usually a natural change. Can also be caused by surgery that removes both ovaries, and some types of chemotherapy.[2][3]
Treatment	None, lifestyle changes[4]
Medication	Menopausal hormone therapy, clonidine, gabapentin, selective serotonin reuptake inhibitors[4][5]

Menopause, also known as the climacteric, is the time when menstrual periods permanently stop, marking the end of reproduction.^[1][6][7] It typically occurs between the ages of 45 and 55, although the exact timing can vary.^[8] Menopause is usually a natural change related to a decrease in circulating blood estrogen levels.^[3] It can occur earlier in those who smoke tobacco.^[2][9] Other causes include surgery that removes both ovaries, some types of chemotherapy, or anything that leads to a decrease in hormone levels.^[10][2] At the physiological level, menopause happens because of a decrease in the ovaries' production of the hormones estrogen and progesterone.^[1] While typically not needed, a diagnosis of menopause can be confirmed by measuring hormone levels in the blood or urine.^[11] Menopause is the opposite of menarche, the time when a girl's periods start.^[12]

In the years before menopause, a woman's periods typically become irregular,^[13][14] which means that periods may be longer or shorter in duration or be lighter or heavier in the amount of flow.^[13] During this time, women often experience hot flashes; these typically last from 30 seconds to ten minutes and may be associated with shivering, night sweats, and reddening of the skin.^[13] Hot flashes^[13] can recur for four to five years.^[6] Other symptoms may include vaginal dryness,^[15] trouble sleeping, and mood changes.^[13][16] The severity of symptoms varies between women.^[6] Menopause before the age of 45 years is considered to be "early menopause" and when ovarian failure/surgical removal of the ovaries occurs before the age of 40 years this is termed "premature ovarian insufficiency".^[17]

In addition to symptoms (hot flushes/flashes, night sweats, mood changes, arthralgia and vaginal dryness), the physical consequences of menopause include bone loss, increased central abdominal fat, and adverse changes in a woman's cholesterol profile and vascular function.^[17] These changes predispose postmenopausal women to increased risks of osteoporosis and bone fracture, and of cardio-metabolic disease (diabetes and cardiovascular disease).^[17]

Medical professionals often define menopause as having occurred when a woman has not had any menstrual bleeding for a year.^[2] It may also be defined by a decrease in hormone production by the ovaries.^[18] In those who have had surgery to remove their uterus but still have functioning ovaries, menopause is not considered to have yet occurred.^[17] Following the removal of the uterus, symptoms of menopause typically occur earlier.^[19] Iatrogenic menopause occurs when both ovaries are surgically removed (Oophorectomy) along with uterus for medical reasons.

The primary indications for treatment of menopause are symptoms and prevention of bone loss.^[20] Mild symptoms may be improved with treatment. With respect to hot flashes, avoiding smoking, caffeine, and alcohol is often recommended; sleeping naked in a cool room and using a fan may help. The most effective treatment for menopausal symptoms is menopausal hormone therapy (MHT).^[15][20] Non-hormonal therapies for hot flashes include cognitive-behavioral therapy, clinical hypnosis, gabapentin, fezolinetant or selective serotonin reuptake inhibitors.^[21][22] These will not improve symptoms such as joint pain or vaginal dryness which affect over 55% of women.^[20] Exercise may help with sleeping problems. Many of the concerns about the use of MHT raised by older studies are no longer considered barriers to MHT in healthy women.^[20] High-quality evidence for the effectiveness of alternative medicine has not been found.^[6]