Menopause Diagnosis

  • Diagnosis

    Menopause is a natural part of aging. It refers to the time in a woman's life when her periods (menses) stop and she is no longer fertile.

    Every woman will experience menopause, or the cessation of her period (menses). This occurs when the ovaries stop functioning. The ovaries are the organs that store and release eggs, and they play a role in hormone levels in the body. When the ovaries stop working, a woman is no longer fertile.

    A woman is said to be in menopause when she has not had a period for 12 months, she has symptoms of menopause such as hot flashes, and no other cause can be established. Not menstruating for an entire year after the age of 45 is the typical definition of menopause. No tests can predict when menopause will happen or how long menopause symptoms may last.

    The age in which women experience menopause varies greatly. Most women reach menopause at around 51 years of age.

    The average age at which a woman reaches menopause is 51 years, but the range is between 45 and 58 years. Although the average time for transition into menopause is 5 years, it can take anywhere from 2 to 8 years. However, menopause can occur abruptly in women of any age who have had their ovaries surgically removed.

    Menopause happens due to a sharp decrease of female hormones in the body. Scientists do not know what triggers the ovaries to stop working and hormone levels to change Figure 01.

    A woman's menstrual cycle is influenced by a complex system of hormones. It is a change in these hormones that causes menopause to occur.

    Two substances - called luteinizing hormone (LH) and follicle-stimulating hormone (FSH) - start the process of the monthly menstrual cycle. They are released into the bloodstream by the brain's pituitary gland, and signal the ovaries in the reproductive system to produce the female sex hormones estrogen and progesterone. Estrogen and progesterone work to prepare a woman's body for possible pregnancy. They prepare an egg for release from the ovaries and cause the lining of the uterus (womb) to thicken so it is ready to provide a good environment should the egg be fertilized and pregnancy occur. If the egg is not fertilized and no pregnancy occurs, hormone levels drop and menstruation begins. During menstruation, the uterine lining is shed and expelled from the body, resulting in bleeding from the vagina. The process then begins all over again.

    With age, the ovaries become less receptive to commands from the pituitary gland. This causes the pituitary gland to produce more LH and FSH, the ovaries secrete less and less estrogen and progesterone, and the menstrual cycle eventually comes to a halt.

    Click to enlarge: Female reproductive anatomy

    Figure 01. Female reproductive anatomy

    Certain factors can influence the age at which menopause begins.

    The age which a woman begins menopause can be influenced by certain factors.

    Cigarette smoking: Smokers experience menopause an average of 1 year earlier than nonsmokers.

    Family history: Genetics also plays a role in the age a woman is likely to experience menopause. Mothers and daughters tend to experience menopause at similar ages.

    Chemotherapy: Chemotherapy and radiation therapy increase the risk of premature menopause.

    Surgery: Hysterectomy (surgical removal of the uterus) alone does not typically trigger early menopause; however, menstrual bleeding will stop after a hysterectomy. If both ovaries are removed (bilateral oophorectomy), menopause starts immediately after surgery, regardless of your age.

    Symptoms of menopause can very widely from woman to woman. The most common symptoms associated with the transition into menopause include irregular periods, hot flashes, night sweats, and vaginal dryness.

    The 4 to 6 years leading up to the final menstrual period are called perimenopause. It is during this time that symptoms are usually most bothersome. Symptoms that are commonly experienced include:

    • Irregular periods
    • Breast tenderness, especially in the early stages of menopause
    • Hot flashes, which are moments of feeling intensely hot, flushed, and sweaty. Hot flashes can last anywhere from 30 seconds to 5 minutes, and can occur multiple times a day.
    • Night sweats
    • Heart pounding or palpitations
    • Vaginal dryness, which may make sex uncomfortable or painful
    • Insomnia
    • Mood changes, irritability, and depression

    Menopause can put you at risk for other conditions. Falling estrogen levels also can have hidden effects, such as bone loss and cholesterol changes that increase heart disease risk Table 01.

    Estrogen has protective effects on the bones and heart. This is one of the reasons why younger women do not suffer from osteoporosis and heart disease to the extent that older women do.

    The period of most rapid postmenopausal bone loss occurs in the first 5 years following menopause. One out of every two women over the age of 50 is at risk for osteoporosis, and one in four will get it unless she takes steps to prevent it. Osteoporosis can result in bone breaks after minor injuries, or even without injury in elderly women.

    Women at higher risk for developing osteoporosis include:

    • Thin Asian and white women
    • Smokers
    • Women who drink alcohol excessively
    • Women who lead a sedentary lifestyle
    • Women who have poor nutritional habits, especially a lack of calcium in the diet
    • Women who take certain medications, such as corticosteroids and medications for thyroid problems

    Heart disease is the number one killer of women. Heart disease worsens more rapidly after menopause because or falling estrogen levels in the body. Less estrogen in the blood increases bad cholesterol (LDL) and decreases good cholesterol (HDL) levels. An unfavorable ratio of these blood fats can lead to heart attack and other cardiovascular (heart and circulation) problems. Table 01.

    Loss of the female sex hormone progesterone increases risk of abnormal thickening of the uterine lining (endometrial hyperplasia) and cancer in some women Table 01.

    Endometrial hyperplasia is an abnormal thickening of the uterine lining (endometrium) that usually is not a serious health risk. However, if endometrial hyperplasia is left untreated it can progress to cancer in some women. Women who have a uterus and take estrogen replacement without accompanying progesterone replacement may increase the risk of developing endometrial hyperplasia.

    Women who are obese or drink alcohol excessively are more vulnerable to endometrial hyperplasia and cancer, as are those with a family history of endometrial cancer, diabetes, or liver disease.

    Irregular vaginal bleeding may indicate an endometrial problem. If you experience changes in your menstrual cycle that last more than 3 months, see your clinician to find out if the changes are related to menopause or another cause.

    Table 1.   Risks Associated With Menopause

    Conditions that may occur due to the hormonal changes of menopause Factors that put you at greater risk for developing the condition
    Osteoporosis Age (bones weaken with age)
    Race (white, Asian)
    Female sex
    Family history
    Slender frame
    Smoking
    Medications (corticosteroids, anticonvulsants, aluminum-containing antacids, thyroid medications)
    Poor nutrition
    Sedentary lifestyle
    Heart disease Smoking
    Hypertension
    Postmenopausal status
    Diabetes
    High LDL cholesterol
    Low HDL cholesterol
    High triglycerides
    Family history
    Uterine cancer Obesity
    Excessive hair
    Abnormal vaginal bleeding
    Liver disease
    Diabetes
    Family history
    High alcohol intake

    A menopause diagnosis is made after a woman over the age of 45 has gone an entire year without having a menstrual period.

    There is no test that can pinpoint when your final menstrual period will occur, but if you could be in menopause, your doctor may check your LH and FSH levels to see if they are elevated. The diagnosis of menopause is made in hindsight, after a woman over the age of 45 has gone 12 months without having a menstrual period, has at least one symptom of menopause, and no other cause of the lack of menses can be found.

    Be sure to get enough calcium and vitamin D to prevent bone loss during and after menopause.

    Getting enough calcium and vitamin D can help prevent osteoporosis, which is associated with menopause. The recommended daily calcium intake for women 50 and over is 1,000 to 1,500 milligrams (mg). This equals about three to five cups of low-fat milk. Most American women consume much less, getting about 500 mg daily; therefore, calcium supplements may be necessary. Vitamin D is needed for calcium to be absorbed, particularly in women over 60 years of age. Many doctors recommend a daily vitamin D intake of 400 international units. Finally, women at risk for osteoporosis should undergo bone mineral density testing.

    Keeping blood pressure under control and cholesterol and blood sugar in check can help lower heart disease risk.

    Eating a healthy diet (low fat, high fiber) and getting plenty of exercise are good ways to keep blood pressure down and prevent cholesterol and blood sugar from being too high. Try for five servings of fruits and vegetables daily and at least 30 minutes of exercise most days of the week.

    It is important to have regular checkups. Your clinician can monitor your cardiovascular disease risk factors by checking your blood pressure, measuring your cholesterol levels, calculating your body mass index (BMI), and measuring your blood sugar levels.

    Perimenopausal women who experience abnormal vaginal bleeding should undergo further evaluation to check for endometrial hyperplasia and cancer.

    Be sure to notify your clinician if you experience irregular or heavy vaginal bleeding. A tissue sample can be removed from your uterine lining and examined under a microscope to see if there are any cellular abnormalities. Ultrasound examination may be performed also.

  • Prevention and Screening

    Be sure to get enough calcium and vitamin D to prevent bone loss during and after menopause.

    Getting enough calcium and vitamin D can help prevent osteoporosis, which is associated with menopause. The recommended daily calcium intake for women 50 and over is 1,000 to 1,500 milligrams (mg). This equals about three to five cups of low-fat milk. Most American women consume much less, getting about 500 mg daily; therefore, calcium supplements may be necessary. Vitamin D is needed for calcium to be absorbed, particularly in women over 60 years of age. Many doctors recommend a daily vitamin D intake of 400 international units. Finally, women at risk for osteoporosis should undergo bone mineral density testing.

    Keeping blood pressure under control and cholesterol and blood sugar in check can help lower heart disease risk.

    Eating a healthy diet (low fat, high fiber) and getting plenty of exercise are good ways to keep blood pressure down and prevent cholesterol and blood sugar from being too high. Try for five servings of fruits and vegetables daily and at least 30 minutes of exercise most days of the week.

    It is important to have regular checkups. Your clinician can monitor your cardiovascular disease risk factors by checking your blood pressure, measuring your cholesterol levels, calculating your body mass index (BMI), and measuring your blood sugar levels.

    Perimenopausal women who experience abnormal vaginal bleeding should undergo further evaluation to check for endometrial hyperplasia and cancer.

    Be sure to notify your clinician if you experience irregular or heavy vaginal bleeding. A tissue sample can be removed from your uterine lining and examined under a microscope to see if there are any cellular abnormalities. Ultrasound examination may be performed also.

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