Menopause
From Standard of Care
Following transition from a reproductive, premenopausal status marked by regular ovulation and cyclic menstruation to a postmenopausal period noted by amenorrhea.
Permanent cessation of menstruation that results from loss of ovarian function.
Can occur naturally, surgically or from medical intervention.
Estradiol levels are typically less than 30 pg/mL in the postmenopausal state.
After menopause circulating estradiol is derived from estrone, which is converted in adipose tissue from adrenal androstenedione.
The transition to menopause is noted by changes in the menstrual cycle with variation in the duration and degree of menstrual flow.
Transition usually begins in mid to late 40s and lasts about 4 years.
Median age occurs at 51 years.
Early in the menopausal transition period cycles are erratic and may be missed.
After 12 months of amenorrhea menopause can be defined, retrospectively.
Alters lipoprotein levels, most frequently in the form of an increase low-density lipoprotein (LDL) cholesterol concentrations.
More than one third of women's lives will occur after cessation of menses.
LH levels higher in perimenopausal women than in younger women.
Level of FSH begins to increase but is generally in the normal range during early menopause.
As transition occurs estrogen levels fall markedly and levels of FSH increase.
Ovulation does not occur after menopause is complete.
After menopause the ovaries do not produce estradiol or progesterone, but continue to produce testosterone.
A small amount of estrogen is produced by the metabolism of adrenal steroids by conversion to estradiol in peripheral fat tissue.
During perimenopausal transition circulating estrogen levels are equivalent or higher than levels in younger women.
There is a decreases in estrogen sensitivity in the menopausal transition period.
Cigarette smokers undergo process about 2 years earlier than nonsmokers.
Change in hormonal milieu associated with perimenopause and menopause can lead to symptoms of hot flashes, night sweats, emotional lability, poor concentration, and sleep disturbance.
Hot flashes and sleep disturbances more common in perimenopausal than in postmenopausal women.
Decrease sensitivity to estrogen during the menopausal period.
Most women enter menopause in their late 40's or early 50's.
The first menstrual changes of menopause are shortening of the cycles followed by erratic cycle length.
Hot flashes often start while the patient is still having menstrual cycles.
Cognitive changes, insomnia, moodiness and decreased libido common problems.
Urogenital symptoms usually occur late in menopausal transition.
With surgical, chemotherapy or radiation induced menopause patients are more likely to experience severe symptoms.
Risk of premature menopause with multiple agent chemotherapy approximately 53-89%.
More than 1 in 3 women are postmenopausal and cardiovascular disease is the number one cause of death in postmenopausal women.
