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

• Menopause is associated with decreased estrogen production which leads to vasomotor symptoms and vulvovaginal atrophy

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, 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 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 (Osteoporosis Self-Assessment Tool for Asians or 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
• 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 (Vit D) deficiency due to lack of sunlight exposure or low intake, thyrotoxicosis or prolonged Levothyroxine intake
• 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