Menopause
Menopause is the permanent cessation of menses from ovarian follicular depletion, confirmed retrospectively after 12 months of amenorrhea around a mean age of 51 years. Management centers on treating moderate to severe vasomotor symptoms with the lowest effective dose of hormone therapy in appropriately selected candidates, alongside bone and cardiovascular risk assessment.
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What this article covers
- Overview
Permanent cessation of menses from ovarian follicular depletion: the ovaries no longer produce enough estrogen to sustain a cycle.
- Epidemiology
Mean age at natural menopause is 51 years, with a typical range of about 42 to 58 years.
- Risk factors
Increasing chronological age: the dominant driver, reflecting depletion of a finite ovarian follicle pool.
- Pathophysiology
Progressive depletion of ovarian follicles initiates the process: the ovary has a finite, non-renewable follicle pool that declines until too few remain for cyclic ovulation.
- Clinical features
The defining criterion is 12 consecutive months of amenorrhea with no other obvious cause: applied retrospectively, this single criterion is necessary and sufficient for natural menopause; no lab or…
- Differential diagnosis
Pregnancy: amenorrhea with irregular cycles still requires a pregnancy test, excluded by a negative beta-hCG.
- Diagnosis
Natural menopause is a clinical diagnosis: 12 consecutive months of amenorrhea with no other pathologic cause, at a typical age (about 42 to 58 years, mean 51); typical age plus hot flushes needs no testing.
- Management
First, confirm contraception is not needed and clear any postmenopausal bleeding before starting therapy: pregnancy remains possible throughout perimenopause, and unexplained bleeding must be worked…
- Complications
Cardiovascular disease: leading cause of postmenopausal death; hormone therapy started over 10 years after onset or at age 60+ raises coronary risk instead of lowering it.
- Prognosis
Menopause is a normal transition; most women navigate it without major complications.
- Prevention
Individualize hormone therapy candidacy with annual reassessment: initiate only for moderate to severe vasomotor symptoms impairing quality of life, at the lowest effective dose, reassessing risk at…
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