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MENOPAUSE & HORMONE THERAPY
Spontaneous/Natural menopause is the final menstrual period 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).
Perimenopause/Menopause transition/Climacteric is the duration when menstrual cycle & endocrine changes occur a few years before and 12 months after the final menstrual period resulting from natural menopause.
Premature menopause is menopause before 40 years of age whether natural or induced while early menopause is spontaneous or induced menopause that occurs before the average age of natural menopause at 51 years or under 45 years of age.

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/Menopause Transition/Climacteric

  • 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 symptoms that occur in women >45 years of age

Premature Menopause

  • Menopause before or at 40 years of age whether natural or induced
  • 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 under 45 years

Early Postmenopause

  • Occurs within 5 years after the final menstrual period

Signs and Symptoms

Menopausal Symptoms

Related to Hormonal Status

  • Hot flushes
  • Night sweats
  • Dyspareunia
  • Vaginal dryness

Not Related to Hormonal Status 

  • Major depression

Potentially Related to Hormonal Status

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

Risk Factors

Fracture and Osteoporosis

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

  • May use Fracture Risk Assessment Tool (FRAX), the World Health Organization (WHO) fracture assessment tool

Non-modifiable

  • Previous history of fracture as an adult
  • History of fracture in 1st-degree relative
  •  Advanced age [low body weight and older age (OSTA)]
  • Poor health/frailty
  • Ethnic group (Asians generally have lower risk compared to Caucasians)
  • Early natural or surgical menopause before 45 years or prolonged premenopausal amenorrhea >1 year

Modifiable

  • Recurrent falls
  • Decreased body weight (<125 lb or 57 kg)
  • Impaired vision
  • Medical conditions: Rheumatoid arthritis, estrogen deficiency, vitamin D (Vit D) deficiency due to lack of sunlight exposure or low intake, thyrotoxicosis or prolonged Levothyroxine intake, chronic liver or renal disease, malabsorptive disease
  • Cigarette smoking
  • Excessive alcohol (>3 drinks/day) and caffeine intake
  • Low calcium (Ca) intake
  • Oral glucocorticoid use ≥5 mg/day of prednisone for ≥3 months
  • Sedentary lifestyle (lack of physical activity)
  • Secondary osteoporosis
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