Menopause%20-and-%20hormone%20therapy Signs and Symptoms

Spontaneous/Natural Menopause

• Final menstrual period confirmed after 12 consecutive months of amenorrhea with no pathological cause

Induced Menopause

• Permanent cessation of menstruation after bilateral oophorectomy (eg surgical menopause) or iatrogenic ablation of ovarian function (eg pelvic radiation therapy, chemotherapy)

Perimenopause/Menopausal Transition/Climacteric

• Perimenopause is the duration when menstrual cycle and endocrine changes occur a few years before and 12 months after the final menstrual period resulting from natural menopause
• Menopausal transition is when there is menstrual cycle variability and lasts up to the final menstrual period 
• Climacteric is the woman’s transition from the reproductive to non-reproductive phase extending from prior to perimenopause to menopause

Premature Menopause

• Menopause before or at 40 years of age whether natural, induced or from medical diseases
• Premature ovarian failure is ovarian insufficiency before 40 years of age resulting in permanent or induced amenorrhea

Early Menopause

• Spontaneous or induced menopause that occurs before the average age of natural menopause at 51 years or <45 years

Early Postmenopause

• Occurs within 5 years after the final menstrual period

• Menopause is associated with decreased estrogen production which leads to vasomotor symptoms (eg hot flushes and night sweats) and genitourinary syndrome of menopause (GSM) [eg urogenital atrophy which includes vaginal dryness, dyspareunia, painful urination, urinary urgency and recurrent urinary tract infections (UTIs)]

Menopausal Symptoms

Related to Hormonal Status

• Hot flushes
• Night sweats
• Dyspareunia
• Vaginal dryness

Potentially Related to Hormonal Status

• Lack of energy, fatigue, sleep disturbances, insomnia
• Depression, anxiety, mood swings, memory loss
• Joint and muscle pain or stiffness, backache
• Urinary incontinence
• Headaches
• Weight gain

Not Related to Hormonal Status 

• Major depression

Fracture and Osteoporosis

The more risk factors that are present, the greater the risk of fracture

• May use the World Health Organization (WHO) Fracture Risk Assessment Tool (FRAX™)
• Osteoporosis Self-Assessment Tool for Asians (OSTA) can be used to identify individuals at risk for osteoporosis, including perimenopausal women with low body mass index (BMI) 

Non-modifiable

• Previous history of non-traumatic fracture as an adult
• History of osteoporotic hip fracture in 1st-degree relative
• Advanced age, female gender 
• Poor health/frailty
• Ethnic group (Asians generally have lower risk compared to Caucasians)
• Premature ovarian insufficiency, early natural or surgical menopause before 45 years or prolonged premenopausal amenorrhea >1 year
• Genetic diseases: Cystic fibrosis, osteogenesis imperfecta, Ehler-Danlos, hemochromatosis, Marfan syndrome

Modifiable

• Recurrent falls
• Decreased body weight (<125 lb or <57.6 kg)
• Impaired vision
• Medical conditions: Rheumatoid arthritis, estrogen deficiency, vitamin D deficiency due to lack of sunlight exposure or low intake, thyrotoxicosis, prolonged Levothyroxine intake, or multiple myeloma
• Cigarette smoking
• Excessive alcohol (≥3 drinks/day) and caffeine intake
• Low calcium (Ca) intake, excessive salt or vitamin A intake
• Oral glucocorticoid use ≥5 mg/day of Prednisone for ≥3 months
• Sedentary lifestyle (lack of physical activity)
• Secondary osteoporosis
• Lack of sun exposure