Menopause is associated with decreased estrogen production which leads to vasomotor symptoms and vulvovaginal atrophy. The woman may experience hot flushes, night sweats, dyspareunia or vaginal dryness. Spontaneous or natural menopause occurs when the final menstrual period is confirmed after 12 consecutive months of amenorrhea with no pathological cause. Induced menopause is the permanent cessation of menstruation after bilateral oophorectomy (ie surgical menopause) or iatrogenic ablation of ovarian function (eg pelvic radiation therapy, chemotherapy).