menopause

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Introduction

Cessation of menstruation with age.

Definitive when amenorrhea has lasted for 12 months.

Etiology

Epidemiology

  • average age of menopause is 51-52 years[49]
  • range is 40-60 years
  • smokers may have accelerated menopause
  • 75-80% of women experience discomfort associated with menopause
  • 10-15% experience symptoms that interfere with activities of daily living
  • 25% complain of symptoms lasting more than 5 years

Pathology

Clinical manifestations

* the 2 manifestations that may be definitively attributed to menopause

# irregular menses with period lasting 15 days is anovulatory bleeding or abnormal vaginal bleeding warranting endometrial biopsy without transvaginal ultrasound in perimenopausal women according to MKSAP19[2]

Laboratory

Diagnostic procedures

Complications

Management

Clinical trials

More general terms

More specific terms

Additional terms

References

  1. ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 451-53
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2009, 2018, 2022.
    Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  3. ↑ Prescriber's Letter 7(8):44 2000
  4. ↑ 4.0 4.1 Journal Watch 20(10):80, 2000 Crawford et al Menopause 7:96, 2000
  5. ↑ Greendale et al Lancet 353:571, 1999
  6. ↑ 6.0 6.1 Solomon DH, in: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  7. ↑ 7.0 7.1 7.2 7.3 Journal Watch 23(3):28, 2003 Barnabei VM et al, Obstet Gynecol 100:1209, 2002
  8. ↑ 8.0 8.1 Prescriber's Letter 11(6):36 2004 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200615&pb=PRL (subscription needed) http://www.prescribersletter.com
  9. ↑ 9.0 9.1 9.2 Journal Watch 24(16):130, 2004 Kreijkamp-Kaspers S, Kok L, Grobbee DE, de Haan EH, Aleman A, Lampe JW, van der Schouw YT. Effect of soy protein containing isoflavones on cognitive function, bone mineral density, and plasma lipids in postmenopausal women: a randomized controlled trial. JAMA. 2004 Jul 7;292(1):65-74. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15238592
  10. ↑ NIH News NIH State-of-the-Science Panel Calls for 'Demedicalization' of Menopause http://www.nih.gov/news/pr/mar2005/od-23.htm
  11. ↑ 11.0 11.1 Journal Watch 25(17):134, 2005 Ockene JK, Barad DH, Cochrane BB, Larson JC, Gass M, Wassertheil-Smoller S, Manson JE, Barnabei VM, Lane DS, Brzyski RG, Rosal MC, Wylie-Rosett J, Hays J. Symptom experience after discontinuing use of estrogen plus progestin. JAMA. 2005 Jul 13;294(2):183-93. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16014592
    Petitti DB. Some surprises, some answers, and more questions about hormone therapy: further findings from the Women's Health Initiative. JAMA. 2005 Jul 13;294(2):245-6. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16014599
  12. ↑ The role of testosterone therapy in postmenopausal women: position statement of The North American Menopause Society http://www.menopause.org/aboutmeno/PStestosterone.pdf corresponding NGC guideline withdrawn 12/10
  13. ↑ 13.0 13.1 Cohen LS et al, Risk for new onset of depression during the menopausal transition: The Harvard study of moods and cycles. Arch Gen Psychiatry 2006; 63:385 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16585467
    Freeman EW et al, Associations of hormones and menopausal status with depressed mood in women with no history of depression Gen Psychiatry 2006; 63:375 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16585466
  14. ↑ Kok HS et al, Heart disease risk determines menopausal age rather than the reverse. J Am Coll Cardiol 2006; 47:1976 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16697313
    Bittner V Menopause and cardiovascular risk. Cause of consequence? J Am Coll Cardiol 2006; 47:1984 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16697314
  15. ↑ 15.0 15.1 Henderson VW. The neurology of menopause. Neurologist. 2006 May;12(3):149-59. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16688016
  16. ↑ 16.0 16.1 Col NF et al Duration of vasomotor symptoms in middle-aged women: A longitudinal study. Menopause 2009 May/Jun; 16:453 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19188852
  17. ↑ 17.0 17.1 Avis NE et al Longitudinal changes in sexual functioning as women transition through menopause: Results from the Study of Women's Health Across the Nation. Menopause 2009 May/Jun; 16:442. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19212271
  18. ↑ 18.0 18.1 Freeman EW et al Efficacy of Escitalopram for Hot Flashes in Healthy Menopausal Women: A Randomized Controlled Trial JAMA. 2011;305(3):267-274 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21245182 <Internet> http://jama.ama-assn.org/content/305/3/267.short
  19. ↑ 19.0 19.1 Bromberger JT et al. Major depression during and after the menopausal transition: Study of Women's Health Across the Nation (SWAN). Psychol Med 2011 Feb 9 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21306662 <Internet> http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8059759
  20. ↑ 20.0 20.1 Levis S et al. Soy isoflavones in the prevention of menopausal bone loss and menopausal symptoms: A randomized, double-blind trial. Arch Intern Med 2011 Aug 8/22; 171:1363 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21824950
  21. ↑ 21.0 21.1 Svejme O et al. Early menopause and risk of osteoporosis, fracture and mortality: A 34-year prospective observational study in 390 women. BJOG 2012 Jun; 119:810. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22531019
  22. ↑ 22.0 22.1 USPSTF Vitamin D and Calcium Supplementation to Prevent Cancer and Osteoporotic Fractures in Adults: U.S. Preventive Services Task Force Recommendation Statement: DRAFT http://www.uspreventiveservicestaskforce.org/draftrec3.htm
  23. ↑ 23.0 23.1 Suzuki H et al. Involvement of estrogen receptor beta in maintenance of serotonergic neurons of the dorsal raphe. Mol Psychiatry 2012 Jun 5 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22665260 <Internet> http://www.nature.com/mp/journal/vaop/ncurrent/full/mp201262a.html
    Phan A et al. Low doses of 17beta-estradiol rapidly improve learning and increase hippocampal dendritic spines. Neuropsychopharmacology 2012 Jun 6 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22669167 <Internet> http://www.nature.com/npp/journal/vaop/ncurrent/full/npp201282a.html
  24. ↑ KEEPS Reports Hormone Therapy Provides Quality of Life Benefits for Newly Menopausal Women North American Menopause Society 23rd Annual Meeting Oct 2012 http://www.menopause.org/annual-meetings/2012-meeting/keeps-report
  25. ↑ 25.0 25.1 El Khoudary SR et al. Progression rates of carotid intima-media thickness and adventitial diameter during the menopausal transition. Menopause 2013 Jan; 20:8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22990755
    Pai JK and Manson JE. Acceleration of cardiovascular risk during the late menopausal transition. Menopause 2013 Jan; 20:1 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23266836
  26. ↑ 26.0 26.1 Chlebowski RT et al. Estrogen alone and joint symptoms in the Women's Health Initiative randomized trial. Menopause 2013 Mar 18; PMID: https://www.ncbi.nlm.nih.gov/pubmed/23511705
    Kaunitz AM. Should new-onset arthralgia be considered a menopausal symptom? Menopause 2013 Mar 18; PMID: https://www.ncbi.nlm.nih.gov/pubmed/23549444
  27. ↑ 27.0 27.1 Lambiase MJ and Thurston RC. Physical activity and sleep among midlife women with vasomotor symptoms. Menopause 2013 Sep; 20:946. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23531686
  28. ↑ 28.0 28.1 28.2 Freeman EW et al Longitudinal Pattern of Depressive Symptoms Around Natural Menopause. JAMA Psychiatry. Published online November 13, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24227182 <Internet> http://archpsyc.jamanetwork.com/article.aspx?articleid=1772342
  29. ↑ Martin KA, Manson JE. Approach to the patient with menopausal symptoms. J Clin Endocrinol Metab. 2008 Dec;93(12):4567-75. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19056840
  30. ↑ Prescriber's Letter 21(3): 2014 Postmenopausal Hormone Therapy CHART: Postmenopausal Hormone Therapy COMMENTARY: Nonhormonal Therapy for Hot Flashes COMMENTARY: New Drug: Osphena (Ospemifene) SPECIAL REPORT: Natural Medicines in the Clinical Management of Menopausal Symptoms Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=300310&pb=PRL (subscription needed) http://www.prescribersletter.com
  31. ↑ 31.0 31.1 Athappilly G and Joffe H Sleep Disturbances During the Menopausal Transition. NEJM Journal Watch. Women's Health. March 11, 2014 Massachusetts Medical Society http://www.jwatch.org/na33784/2014/03/11/sleep-disturbances-during-menopausal-transition (subscription may be needed) http://www.jwatch.org
  32. ↑ Huang AJ, Grady D, Jacoby VL Persistent hot flushes in older postmenopausal women. Arch Intern Med. 2008 Apr 28;168(8):840-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18443259
  33. ↑ 33.0 33.1 Brotman RM et al. Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy. Menopause 2014 May; 21:450 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24080849 <Internet> http://journals.lww.com/menopausejournal/pages/articleviewer.aspx?year=2014&issue=05000&article=00005&type=abstract
  34. ↑ North American Menopause Society http://www.menopause.org/aboutmeno/PScalcium.pdf
  35. ↑ 35.0 35.1 Manson JE et al. MenoPro: A mobile app for women bothered by menopause symptoms. Menopause 2014 Oct http://www.menopause.org/for-women/menopro-a-mobile-app-for-women-bothered-by-menopause-symptoms
  36. ↑ 36.0 36.1 Crandall CJ et al. Postmenopausal weight change and incidence of fracture: Post hoc findings from Women's Health Initiative observational study and clinical trials. BMJ 2015 Jan 27; 350:h25 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25627698 <Internet> http://www.bmj.com/content/350/bmj.h25
  37. ↑ Agency for Healthcare Research and Quality Menopausal Symptoms: Comparative Effectiveness of Therapies. Research Review - Final - Mar. 5, 2015 http://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=2051
  38. ↑ 38.0 38.1 Triebner K, Johannessen A, Puggini L et al. Menopause as a predictor of new-onset asthma: A longitudinal Northern European population study. J Allergy Clin Immunol 2016 Jan; 137:50. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26435006
  39. ↑ Manson JE, Kaunitz AM Menopause Management - Getting Clinical Care Back on Track. N Engl J Med 2016; 374:803-806. March 3, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26348174 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMp1514242
  40. ↑ American College of Obstetricians and Gynecologists (ACOG) ACOG Practice Bulletin No. 141: Management of menopausal symptoms. Obstet Gynecol. 2014 Jan;123(1):202-16 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24463691
  41. ↑ 41.0 41.1 41.2 41.3 41.4 41.5 Franco OH, Chowdhury R, Troup J Use of Plant-Based Therapies and Menopausal Symptoms. A Systematic Review and Meta-analysis. JAMA. 2016;315(23):2554-2563 PMID: https://www.ncbi.nlm.nih.gov/pubmed/2732780
  42. ↑ 42.0 42.1 Muka T, Oliver-Williams C, Kunutsor S et al Association of Age at Onset of Menopause and Time Since Onset of Menopause With Cardiovascular Outcomes, Intermediate Vascular Traits, and All-Cause MortalityA Systematic Review and Meta-analysis. JAMA Cardiol. Published online September 14, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27627190 <Internet> http://cardiology.jamanetwork.com/article.aspx?articleid=2551981
    Manson JE, Woodruff TK Reproductive Health as a Marker of Subsequent Cardiovascular Disease. The Role of Estrogen. JAMA Cardiol. Published online September 14, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27626902 <Internet> http://cardiology.jamanetwork.com/article.aspx?articleid=2551979
  43. ↑ 43.0 43.1 Joffe H, Crawford SL, Freeman MP et al Independent Contributions of Nocturnal Hot Flashes and Sleep Disturbance to Depression in Estrogen-Deprived Women. J Clin Endocrinol Metab. 2016 Oct;101(10):3847-3855. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27680875
  44. ↑ Rahimikian F, Rahimi R, Golzareh P, Bekhradi R, Mehran A. Effect of Foeniculum vulgare Mill. (fennel) on menopausal symptoms in postmenopausal women: a randomized, triple-blind, placebo-controlled trial. Menopause. May 15, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28509813 <Internet> http://journals.lww.com/menopausejournal/Abstract/publishahead/Effect_of_Foeniculum_vulgare_Mill___fennel__on.97782.aspx
  45. ↑ 45.0 45.1 Guthrie KA, Larson JC, Ensrud KE et al. Effects of pharmacologic and nonpharmacologic interventions on insomnia symptoms and subjective sleep quality in women with hot flashes: A pooled analysis of individual participant data from 4 MsFLASH trials. Sleep 2017 Nov 20 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29165623 https://academic.oup.com/sleep/advance-article-abstract/doi/10.1093/sleep/zsx190/4642822?redirectedFrom=fulltext
  46. ↑ 46.0 46.1 Dunneram Y, Greenwood DC, Burley VJ, Cade JE. Dietary intake and age at natural menopause: results from the UK Women's Cohort Study. J Epidemiol Community Health 2018 Apr 30 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29712719 Free full text <Internet> http://jech.bmj.com/content/early/2018/04/10/jech-2017-209887
  47. ↑ 47.0 47.1 van Driel C, Stuursma AS, Schroevers MJ, Mourits M, de Bock GH. Mindfulness, cognitive behavioural and behaviour-based therapy for natural and treatment-induced menopausal symptoms: A systematic review and meta-analysis. BJOG 2018 Mar 15 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29542222
  48. ↑ 48.0 48.1 48.2 Zhao D, Guallar E, Ouyang P et al Endogenous Sex Hormones and Incident Cardiovascular Disease in Post-Menopausal Women. J Am Coll Cardiol 71(22): June 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29852978 <Internet> http://www.onlinejacc.org/content/71/22/2555
    Miller VM, Mankad R Sex Steroids and Incident Cardiovascular Disease in Post- Menopausal Women. New Perspective on an Old Controversy. J Am Coll Cardiol 71(22): June 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29852979 <Internet> http://www.onlinejacc.org/content/71/22/2567
  49. ↑ 49.0 49.1 49.2 Kuh D, Cooper R, Moore A, Richards M, Hardy R. Age at menopause and lifetime cognition: Findings from a British birth cohort study. Neurology 2018 May 8; 90:e1673 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29643079 Free PMC Article <Internet> http://n.neurology.org/content/90/19/e1673
  50. ↑ Grady D. Clinical practice. Management of menopausal symptoms. N Engl J Med 2006 Dec 1; 355:2338 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17135587 Free full text https://www.nejm.org/doi/full/10.1056/NEJMcp054015
  51. ↑ Stuenkel CA, Davis SR, Gompel A et al. Treatment of symptoms of the menopause: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2015 Nov; 100:3975-4011. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26444994
  52. ↑ 52.0 52.1 FDA News Release. Oct 24, 2019 FDA permits marketing of a diagnostic test to aid in the determination of menopausal status. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm624284.htm
  53. ↑ 53.0 53.1 Lund KS, Siersma V, Brodersen J, Waldorff FB. Efficacy of a standardised acupuncture approach for women with bothersome menopausal symptoms: a pragmatic randomised study in primary care (the ACOM study). BMJ Open. 9(1) 2019 https://bmjopen.bmj.com/content/9/1/e023637
  54. ↑ 54.0 54.1 Ainsworth AJ et al. Tubal ligation and age at natural menopause. Obstet Gynecol 2019 Jun; 133:1247. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31135741 https://insights.ovid.com/crossref?an=00006250-201906000-00024
  55. ↑ Santoro N, Johnson J. Diagnosing the Onset of Menopause. JAMA. Published online July 22, 2019 (Multimedia) PMID: https://www.ncbi.nlm.nih.gov/pubmed/31329213 https://jamanetwork.com/journals/jama/fullarticle/2739289
  56. ↑ 56.0 56.1 56.2 56.3 NEJM Knowledge+ Question of the Week. Sept 24, 2019 https://knowledgeplus.nejm.org/question-of-week/1760/
    Carroll DG, Lisenby KM, Carter TL. Critical appraisal of paroxetine for the treatment of vasomotor symptoms. Int J Womens Health 2015; 7:615 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26124682 Free PMC Article
    Pinkerton JV, Joffe H, Kazempour K, Mekonnen H, Bhaskar S, Lippman J. Low-dose paroxetine (7. 5 mg) improves sleep in women with vasomotor symptoms associated with menopause. Menopause 2015 Jan; 22:50. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25137243 Free PMC Article
  57. ↑ 57.0 57.1 Zhu D, Chung HF, Dobson AJ et al. Age at natural menopause and risk of incident cardiovascular disease: A pooled analysis of individual patient data. Lancet Public Health 2019 Oct 3; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31588031 Free Article https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(19)30155-0/fulltext
  58. ↑ 58.0 58.1 58.2 LaMonte MJ, Wactawski-Wende et al. Association of physical activity and fracture risk among postmenopausal women. JAMA Netw Open 2019 Oct 2; 2:e1914084 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31651972 Free PMC Article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2753526
  59. ↑ 59.0 59.1 Honigberg MC et al. Association of premature natural and surgical menopause with incident cardiovascular disease. JAMA 2019 Nov 18 PMID: https://www.ncbi.nlm.nih.gov/pubmed/1738818 https://jamanetwork.com/journals/jama/article-abstract/2755841
  60. ↑ 60.0 60.1 O'Keeffe LM, Kuh D, Fraser A et al Age at period cessation and trajectories of cardiovascular risk factors across mid and later life Heart. Feb 2020 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32098806 Free Article https://heart.bmj.com/content/early/2020/01/31/heartjnl-2019-315754
    Gersh FL, Lasvie CJ Menopause and hormone replacement therapy in the 21st century Heart. Feb 2020 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32098805 https://heart.bmj.com/content/early/2020/01/31/heartjnl-2019-315898
  61. ↑ 61.0 61.1 Langton CR, Whitcomb BW, Purdue-Smithe AC et al. Association of parity and breastfeeding with risk of early natural menopause. JAMA Netw Open 2020 Jan 3; 3:e1919615 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31968114 Free PMC Article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2759124
  62. ↑ 62.0 62.1 62.2 62.3 62.4 62.5 El Khoudary SR et al. Menopause transition and cardiovascular disease risk: Implications for timing of early prevention: A scientific statement from the American Heart Association. Circulation 2020 Dec 22; 142:e506 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33251828 https://www.ahajournals.org/doi/10.1161/CIR.0000000000000912
  63. ↑ Crandall CJ, Mehta JM, Manson JE Management of Menopausal Symptoms. A Review. JAMA. 2023;329(5):405-420 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36749328 https://jamanetwork.com/journals/jama/fullarticle/2801054
  64. ↑ Burger HG. Unpredictable endocrinology of the menopause transition: clinical, diagnostic and management implications. Menopause Int. 2011;17:153-4. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22120939
  65. ↑ McNeil MA, Merriam SB. Menopause. Ann Intern Med. 2021;174:ITC97-ITC112. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34251902
  66. ↑ British Menopause Society http://www.thebms.org.uk/

Patient information

menopause patient information

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