Menopause is the transition from reproductive to non-reproductive phase which refers to the natural part of the aging and is a normal life stage of every woman. However, there is a large individual variation and each woman experiences menopause in a different way. One woman may go smoothly through these hormonal changes, while another can suffer with many debilitating symptoms until she receives proper treatment.
Stages of menopause
Perimenopause is a transitional period from a normal to completely absent ovarian function. During this time ovarian function becomes erratic with fluctuations in estrogen levels that results in some physical symptoms such as hot flashes, night sweats, headaches, mood swings and irregular periods. Perimenopause usually begins when a woman is in her 40s and lasts as long as four to eleven years.
During perimenopause the ovaries start to decrease their ovulatory function. The majority of women do not notice the menopause onset until they reach the last few years of perimenopause when estrogen production drops more quickly and dramatically.
Menopause begins when the ovaries stop to release eggs and a woman no longer has periods. Menopause usually occurs between the ages of 45 and 55 with an average age of 51 in the US. A general indication of menopause is cessation of periods for 12 consecutive months.
The postmenopausal time is divided into two stages:
• Early postmenopause is within the first five years since the last menstrual period. At this stage hormone therapy is initiated if the symptoms, osteoporosis and bone loss become severe.
• Late postmenopause is five years and beyond.
Who is more likely to experience the symptoms of menopause
• Women with personal or family history of breast or ovarian cancer
• Women who have blood clots
• Women with personal or family history of hormonal abnormalities
• Women with autoimmune diseases and thyroid problems
• Women who have early menopause
• Women with surgical removal of the ovaries, after chemo- or radiation therapy
Factors affecting menopause
It is not well understood why the age of the menopause onset varies form woman to woman. Many environmental and lifestyle factors such as the use of oral contraceptives and smoking are related to the beginning of the natural menopause.
Genetics determines the number of eggs in the woman's ovaries and the age when she goes into menopause. A strong association between genetics and the onset of the menopause were found based on the studies of the menopausal age of mothers, daughters and between siblings. If the women in your family went into menopause around 50, chances are 30 to 85% that you will experience menopause around this time also.
Smokers and women with chronic illness, autoimmune diseases, surgical removal of the ovaries or damage to the ovaries from the chemotherapy or radiation therapy are more likely to experience an early menopause. On average smokers reach the menopause two years earlier than non-smokers.
Early menopause
Premature menopause is characterized by the absence of normal ovarian functions and occurs in less than 1% of women under the age of 40 and 0.1% before the age of 30.
Clinical diagnosis of early menopause is based on the absence of periods for at least 4 months in combination with FSH levels exceeding 40 IU/L before age of 40. However, about half of the patients show intermittent estrogen production and could ovulate making pregnancy possible after a diagnosis is made.
Around menopause many women experience symptoms such as palpitations, heat intolerance and hot flashes that are believed to be caused by fluctuations of estrogen. Often these symptoms are mistaken for hypothyroidism, hashitoxicosis or aging.
The incidence of premature ovarian failure of the autoimmune origin is higher in women with Hashimoto's and Grave's disease. Premature ovarian failure or oophoritis is a painless autoimmune inflammation of the ovaries resulting in early menopause before age forty with a loss of fertility and ovary hormonal functions.
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