Menopause%20-and-%20hormone%20therapy Signs and Symptoms
Definition
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
Signs and Symptoms
- 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
Risk Factors
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