Helena J Teede
Menopause is the permanent cessation of menstruation resulting from loss of ovarian follicular activity and is diagnosed retrospectively following 12 months of amenorrhea in association with elevated gonadotrophins and oestrogen deficiency.1 Premature menopause occurs before the age of 40 years and early menopause before 45 years. Menopause can be spontaneous or can be induced by chemotherapy, radiotherapy or surgery. The time leading up to the menopause – the menopause transition – is characterised by declining ovarian follicle numbers, menstrual irregularity and hormonal changes including increasing follicle stimulating hormone, decreasing inhibin B and anti-mullerian hormone, and variable oestradiol levels.2 Testosterone levels decline during early to mid reproductive life with little change during the menopause transition.3 The average age of spontaneous natural-age menopause is 51 years, with the menopause transition commencing at 47.5 years. Risk factors associated with an earlier menopause include smoking, positive family history and pelvic surgery (including hysterectomy).4
Menopause is the permanent cessation of menstruation
resulting from loss of ovarian follicular activity. The
characteristic symptoms of a fall in oestrogen are vasomotor
and urogenital atrophy symptoms; with symptoms
reported by up to 85% of women over a mean duration of
5.2 years. Long term consequences of menopause include
osteoporosis and cardiovascular disease. Menopause
management is highly controversial and can be confusing
for both clinicians and their women patients.
To explore menopausal management options including
comprehensive evaluation; lifestyle modification for
symptom relief and risk prevention; hormone therapy or
nonhormonal alternatives for symptom relief; prevention
and treatment of long term risks; and education and
psychological support and therapy.
Use of hormone therapy involves consideration of the
woman’s risk-benefit profile. We attempt to clarify this
complex topic and focus on the impact of hormone therapy
in women aged 50–59 years, including the benefits of
relief of hot flushes and urogenital atrophy symptoms and
the prevention of fractures and diabetes; and the risks,
including venothrombotic episodes, stroke, cholecystitis
and breast cancer (with combined oestrogen and
progestogen only). Nonhormonal options are also explored.
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