Menopause Post

Menopause is the permanent cessation of menstruation which occurs a considerable length of time before the end of the lifespan.

The word was first applied to humans, and because of this it literally means the cessation of monthly cycles or menstrual cycles, from the Greek roots meno (month) and pausis (a halt). However, the word is not only applied to humans, and menopause is the permanent stopping of female reproductive cycles of various lengths and kinds; menopause is indeed present in a number of vertebrate species other than humans.

In adult human females who still have a uterus, and who are not pregnant or lactating, postmenopause is identified by a permanent (at least one year's) absence of monthly periods or menstruation. In women without a uterus, menopause or postmenopause is identified by a very high FSH level.

In human females, menopause usually happens more or less in midlife, signaling the end of the fertile phase of a woman's life. Menopause is perhaps most easily understood as the opposite process to menarche, the start of the monthly periods. However, menopause in women cannot satisfactorily be defined simply as the permanent "stopping of the monthly periods", because in reality what is happening to the uterus is quite secondary to the process; it is what is happening to the ovaries that is the crucial factor.

For medical reasons, the uterus must sometimes be surgically removed (hysterectomy) in a younger woman; her periods will cease permanently, and the woman will technically be infertile, but as long as at least one of her ovaries is still functioning, the woman will not have reached menopause; even without the uterus, ovulation and the release of the sequence of reproductive hormones will continue to cycle on until menopause is reached. But in circumstances when a woman's ovaries are removed (oophorectomy), even if the uterus were to be left intact, the woman will immediately be in "surgical menopause".

Thus menopause is based on the natural or surgical cessation of hormone production by the ovaries, which are a part of the body's endocrine system of hormone production, in this case the hormones which make reproduction possible and may influence sexual behavior. The resultant decreased levels of circulating estrogen impacts entire cascade of a woman's reproductive functioning, from brain to skin.

The menopause transition, and post-menopause itself, is a natural life change, not a disease state or a disorder. The transition itself can be challenging for a number of women, but for others it is not difficult.

Overview

Menopause starts as the functioning of the ovaries begin to change. The ripening and release of the ovum (which, during the reproductive years leads to ovulation and then menstruation if pregnancy does not occur), becomes unpredictable. Ovulations start to be skipped, and the menstrual cycle starts to become less reliable in timing. As these changes become more pronounced, periods start to be skipped, and other perimenopausal symptoms may appear.

After a number of years of erratic functioning, the ovaries almost completely stop producing progesterone and two out of the three estrogen hormones: estradiol and estriol. Estrone is one estrogen which is still produced in reasonable amounts in post-menopausal women. Testosterone levels decrease; however, a decrease in testosterone levels begins gradually in young adulthood. Testosterone levels are thought not to drop significantly during the menopause transition because the stroma of the postmenopausal ovary and the adrenal gland still continue to secrete small amounts of testosterone, even during post-menopause.

Menopause is the end of the reproductive years rather than the beginning, and thus it is the opposite of menarche, nonetheless it can usefully be compared with that event: the menopause transition years are in many ways similar to puberty in that women experience hormonal fluctuations which usher in a new stage of life. Similar to pubescent girls, menopausal women are often unfamiliar or uneducated about the types of bodily changes they are undergoing, and may require a period of adjustment to the accompanying effects of these changes.

Age of onset

The typical age range for the occurrence of menopause is between the age of 45 and 55. The average age of menopause varies according to geographic location. In the Western world, the average age of menopause is 51 years. In some developing countries, such as India and the Philippines, the median age of natural menopause is considerably earlier, at 44 years.

In the Western World, last period ever occurring between the ages of 55 to 60 is known as a "late menopause", and an "early menopause" is defined as having one's final period somewhere between the ages of 45 to 50.

Rarely, the ovaries stop working at a very early age, anywhere from the age of puberty to age 20, and this is known as premature ovarian failure (POF), also commonly referred to as "premature menopause". 1% of women experience POF, and it is not considered to be due to the normal effects of aging. Some known causes of premature menopause include autoimmune disorders, thyroid disease, diabetes mellitus, chemotherapy, eating disorders, and radiotherapy. However, in the majority of spontaneous cases of premature menopause, the cause is unknown.

Premature menopause is diagnosed or confirmed by measuring the levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH); the levels of these hormones will be abnormally high if menopause has occurred. Rates of premature menopause have been found to be significantly higher in fraternal and identical twins; approximately 5% of twins reach menopause before the age of 40. The reasons for this are not completely understood. Transplants of ovarian tissue between identical twins have been successful in restoring fertility.

On average, women who smoke cigarettes experience menopause significantly earlier than non-smokers.

Menopause in other species

Menopause in the animal kingdom appears perhaps to be somewhat uncommon, although the incidence in different species has by no means been thoroughly researched. However, it is already quite apparent that humans are not the only species that experience it. Menopause has been observed in rhesus monkeys and all other primates, some cetaceans, as well as in a variety of other vertebrate species including the guppy, the platyfish, the budgerigar, the laboratory rat and mouse, and the opossum.

Menopause in human evolution

The Grandmother hypothesis suggests that menopause evolved in humans because it promotes the survival of grandchildren. According to this hypothesis, post reproductive women feed and care for children, adult nursing daughters, and grandchildren whose mothers have weaned them. Human babies require large and steady supplies of glucose to feed the growing brain. In infants in the first year of life, the brain consumes 60% of all calories, so both babies and their mothers require a dependable food supply. Some evidence suggests that hunters contribute less than half the total food budget of most hunter-gatherer societies, and often much less than half, so that foraging grandmothers can contribute substantially to the survival of grandchildren at times when mothers and fathers are unable to gather enough food for all of their children. In general, selection operates most powerfully during times of famine or other privation. So although grandmothers might not be necessary during good times, many grandchildren cannot survive without them during times of famine.

Social and psychological significance: the three ages

The end of fertility in midlife ushers in the third part of a woman's life, also known as the "third age". Many women in Western culture live long enough that half of their adult life is spent in post-menopause. For some women, the menopausal transition represents a major life change, similar to menarche in the magnitude of its social and psychological significance.

In the ancient past, menarche and menopause were considered to mark the transitions from "maiden" to "matron", and from "matron" to "crone", (in other words, from little girl to reproductive woman and then to older woman.) Although the significance of the changes that surround menarche is still fairly well recognized, in countries such as the USA, the social and psychological ramifications of the menopause transition are frequently ignored or underestimated.

Terminology, definitions and commentary

Menopause

Clinically speaking, menopause is a date. For those women who still have a uterus, menopause is defined as the day after a woman's final period finishes. This date is fixed retrospectively, once 12 months have gone by with no menstrual flow at all. At this point a woman is considered to be a year into postmenopause, is considered to be infertile, and no longer needs to take into consideration the possibility of pregnancy.

In common everyday parlance however, the word "menopause" is usually not used to refer to one day, but to the whole of the menopause transition years. This span of time is also referred to as the change of life , the change , or the climacteric and more recently is known as "perimenopause", (literally meaning "around menopause").

The word menopause is also often used in popular parlance to mean all the years of

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