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How Are Menopause And The Climacteric Related

When Does Menopause Begin And How Long Does It Last

Menopause related to some weight gain on your waist

Most women first begin developing menopause symptoms about four years before their last period. Symptoms often continue until about four years after a womans last period.

A small number of women experience menopause symptoms for up to a decade before menopause actually occurs, and 1 in 10 women experience menopausal symptoms for 12 years following their last period.

The median age for menopause is 51, though it may occur on average up to two years earlier for Black and Latina women. More studies are needed to understand the onset of menopause for women of color.

There are many factors that help determine when youll begin menopause, including genetics and ovary health. Perimenopause occurs before menopause. Perimenopause is a time when your hormones begin to change in preparation for menopause.

It can last anywhere from a few months to several years. Many women begin perimenopause some point after their mid-40s. Other women skip perimenopause and enter menopause suddenly.

About 1 percent of women begin menopause before the age of 40, which is called premature menopause or primary ovarian insufficiency. About 5 percent of women undergo menopause between the ages of 40 and 45. This is referred to as early menopause.

What Happens And How Does It Feel

For some women this loss of reproductive ability may be deeply felt, and for all women the menopause is a personal experience, not just a medical condition. However, the diminishing release of oestrogen from the ovary as women advance into their 40s is often the cause of symptoms which can be distressing and may need medical attention.

Hot flushes are the most common symptom of the menopause, occurring in three in every four menopausal women. Other common symptoms include night sweats, sleeplessness, vaginal dryness, irritated skin, more frequent urinary incontinence and urinary tract infections, low mood and a reduced interest in sex. Symptoms vary hugely in duration, severity and what impact they have on women.

All the common symptoms of the menopause are associated with a decrease in the bodys production of oestrogen. Oestrogen lack can affect many parts of the body, including the brain, causing changes in emotional well-being, and the skin, influencing its elasticity and thickness.

There is also some evidence that oestrogen deficiency is the cause of some chemical changes in the body which make women after the menopause especially vulnerable to heart disease and stroke.

Selective Estrogen Receptor Modulators

SERMs are a category of drugs, either synthetically produced or derived from a botanical source, that act selectively as agonists or antagonists on the estrogen receptors throughout the body. The most commonly prescribed SERMs are raloxifene and tamoxifen. Raloxifene exhibits oestrogen agonist activity on bone and lipids, and antagonist activity on breast and the endometrium. Tamoxifen is in widespread use for treatment of hormone sensitive breast cancer. Raloxifene prevents vertebral fractures in postmenopausal, osteoporotic women and reduces the risk of invasive breast cancer.

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Further Information On Cme

This article has been certified by the North Rhine Academyfor Postgraduate and Continuing Medical Education. Deutsches Ärzteblatt provides certified continuing medical education in accordance with the requirements of the Medical Associations of the German federal states . CME points of the Medical Associations can be acquired only through the Internet, not by mail or fax, by the use of the German version of the CME questionnaire within 6 weeks of publication of the article. See the following website:

Participants in the CME program can manage their CME points with their 15-digit uniform CME number . The EFN must be entered in the appropriate field in the website under meine Daten , or upon registration. The EFN appears on each participants CME certificate. The solutions to the following questions will be published in issue 25/2012.

The CME unit Insect Stings: Clinical Features and Management can be accessed until 11 May 2012. For issue 21/2012, we plan to offer the topic Acute Confusional States in the Elderly.

Solutions to the CME questions in issue 9/2012:

Horneber M et al.: Cancer-Related Fatigue.

Solutions: 1a, 2d, 3c, 4e, 5a, 6b, 7d, 8d, 9b, 10c

What Can Be Done

How to Loose Weight Around Menopause (and Keep it Off ...

Lifestyle factors

A healthy lifestyle can minimize the effects of the menopause, helping to keep the heart and bones strong. Many women feel that this is a good time to review the way they treat their body. Here are some tips to consider:

Complementary & alternative therapies

These have become a popular choice and many women use them, although limited scientific research has been done to support their effect or indeed their safety. They may sometimes help with troublesome symptoms, but they are unlikely to have a significant impact on bone strength, the heart or blood vessels.

Choosing a complementary or alternative therapy can be a challenge so many different ones exist. Acupuncture, aromatherapy, herbal treatments, homeopathy, hypnotherapy, yoga and reflexology have all been reported as being helpful in the menopause.

To find out more about available therapies, please consult the WHC fact sheet Complementary/alternative therapies for menopausal women.

Hormone Replacement Therapy

Hormone replacement therapy is the most effective and widely used treatment for menopausal symptoms. As its name suggests, it is simply a way of replacing the hormone oestrogen that is lost during the menopause.

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Menopause And Adhd: Conclusions

Estrogen loss during all three stages of menopause affects several important neurotransmitters that regulate cognitive function and emotion, in turn causing some women to experience physical and cognitive changes that range from mild to severe. We do not know how to predict who will experience these impairments or why. Whats more, menopause symptoms unequivocally mimic ADHD symptoms, and may even be one mechanism for adult onset ADHD.

Research has not yet determined whether women with ADHD are more affected, or differently affected, by menopause. But given what we know about challenges associated with ADHD, and the impact of estrogen loss on executive functioning in non-ADHD women, we can safely assume that women with ADHD are more vulnerable to challenges during menopause. Treatments for menopausal women with ADHD should take into account the various considerations we have discussed here.

Menopause And Adhd: Next Steps

The content for this article was derived from the ADDitude Expert WebinarMenopause and ADHD: How Estrogen Changes Impact Dopamine, Cognition, and Womens Health with Janette Wasserstein, Ph.D., which was broadcast live on November 18, 2021.

SUPPORT ADDITUDEThank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

1 Luine V. N. . Estradiol and cognitive function: past, present and future. Hormones and behavior, 66, 602618.

2 Russell, J. K., Jones, C. K., & Newhouse, P. A. . The Role of Estrogen in Brain and Cognitive Aging. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 16, 649665.

3 Le, J., Thomas, N., & Gurvich, C. . Cognition, The Menstrual Cycle, and Premenstrual Disorders: A Review. Brain sciences, 10, 198.

4 Roberts, B., Eisenlohr-Moul, T., & Martel, M. M. . Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology, 88, 105114.

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Please Answer The Following Questions To Participate In Our Certified Continuing Medical Education Program Only One Answer Is Possible Per Question Please Select The Answer That Is Most Appropriate

Question 1

Which of the following climacteric symptoms are consistently present?

  • Sleep disturbances and bodily symptoms

  • Heat waves and vaginal dryness

  • Urinary tract symptoms and sexual problems

  • Mood changes and sleep disturbances

  • Bodily symptoms and mood changes

  • Question 2

    Oral hormone therapy elevates the risk of which of the following diseases?

  • Urticaria

  • Question 4

    What mode of application of hormone therapy is NOT effective for the treatment of vasomotor symptoms?

  • transdermal

  • intramuscular

  • Question 5

    A perimenopausal patient asks you for information about hormone therapy and the risk of venous thromboembolism. What should you tell her?

  • Hormone therapy lowers the risk.

  • Estrogen monotherapy changes the risk to the same extent as combined estrogen-progestagen therapy.

  • The risk is markedly elevated in the first year of hormone therapy.

  • Obesity and thrombophilia have no effect on the risk of venous thromboembolism.

  • An elevated risk has only been observed after multiple years of hormone therapy.

  • Question 6

    Hormone therapy elevates the risk of breast cancer. For what type and duration of therapy has this been demonstrated?

  • ET for 3 years

  • EPT for 5 years or more

  • ET for 1 year

  • EPT for 1 year

  • Question 7

    What type of hormone therapy does NOT elevate the risk of endometrial carcinoma in women who have not undergone hysterectomy?

  • pure ET

  • EPT with five days of gestagen administration per month

  • EPT with twelve days of gestagen administration per quarter

  • Question 8

    Question 9

    A Brief Review Of Neuropsychic Symptoms Associated With The Female Climacteric: Depression And Mental Health

    New treatment for women suffering from menopause-related depression

    Cristina Wigg,1,2,3

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    1Departamento de Psicometria, Universidade Federal do Rio de Janeiro, Brazil2Setor de Neuropsicologia, Universidade Federal do Rio de Janeiro, Brazil3Coordenadora de Saúde Mental do Projeto de Criação do Centro de Atenção Integral à Mulher no Climatério, do Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira da Fiocruz, Brazil

    Correspondence: Cristina Wigg Setor de Neuropsicologia, Instituto de Neurologia Deolindo Couto, Universidade Federal do Rio de Janeiro Av.Venceslau Brazil, 95 2229-14 Rio de Janeiro RJ, Brazil

    Citation: Wigg C A Brief Review of Neuropsychic Symptoms Associated with the Female Climacteric: Depression and Mental Health. J Neurol Stroke 7: 00248. DOI: 10.15406/jnsk.2017.07.00248

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    What Are The Symptoms Of The Menopause

    Common peri-menopausal signs and symptoms include:

    • Irregular periods
    • Hot flushes/night sweats
    • Difficulty sleeping
    • Changes in skin: laxity, reduced body and scalp hair, and dryness.

    The term genitourinarysyndrome of menopause describes:

    • Vaginal dryness, burning and irritation
    • Sexual symptoms: lack of lubrication, discomfort, pain
    • Urinary symptoms: urgency, dysuria, and recurrent urinary tract infections.

    What Does Climacteric State Mean


    Thereof, what is climacteric syndrome?

    The climacteric syndrome is a set of symptoms caused by the decline of ovarian hormone levels, which alters brain neurotransmission and provokes musculoskeletal pains, mood disorders, poor sleep quality and hot flushes. Some antidepressants may be useful for patients with climacteric symptoms.

    Similarly, what does climacteric mean in medical terms? Medical Definition of ClimactericClimacteric: 1. The menopause in women. 2. The corresponding time in the life of men. From the Greek klimakter, meaning literally a rung of a ladder or figuratively a critical point.

    Consequently, what is the difference between menopause and climacteric?

    Globally, the term menopause is much more frequently used than climacteric but, before we use either one, we should consider that ‘menopause‘ is referring to a specific event, the cessation of menses, and ‘climacteric‘ to gradual changes of ovarian function that start before the menopause and continue thereafter for a

    What does menopausal and female climacteric states mean?

    627.2 Symptomatic menopausal or female climacteric states and may include these symptoms: crisis, flushing, headache, insomnia/sleeplessness, lack of focus/concentration, neurosis, and psychoneurosis. These codes are used for natural or age-related menopause.

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    Role Of Hormone Therapy

    Gillian wonders whether hormone therapy would help.

    Gynecologists have concentrated on determining which symptoms can truly be attributed to an estrogen-deficient state and are thus amenable to hormone replacement therapy. The most reliable way of determining response to hormones is via the randomized, double-blind clinical trial. To date, most trials that have assessed effects on mood and sexual functioning have had relatively small sample sizes. The stage of menopausal transition of the women participants has not always been clarified. There are also some difficulties in extrapolating results from studies of women who have undergone hysterectomy and bilateral oophorectomy to women who have retained their ovaries. Many of the trials failed to use validated and reliable assessments of mood and sexual functioning.

    A review of six earlier double-blind studies found that all but one study reported that compared with placebo, there was a decrease in mood-related complaints, such as irritability, fatigue, insomnia, anxiety, and depression.42

    To summarize, most double-blind studies have found that estrogens have beneficial effects on mood and sexual functioning. The addition of a progestin leads to less favorable results. Factors involved in determining the acceptability of progestins were reviewed.48 Personality variables, dosage, and type of progestins used, and individual patient vulnerability may be important in determining the response to treatment.


    Substances Used For Hormone Therapy

    Guide to Balance Out between Menopause and Sexual Health

    In non-hysterectomized women, combined estrogen-gestagen therapy must be administered instead of estrogen therapy alone in order not to elevate the risk of endometrial hyperplasia and endometrial carcinoma. Both oral and transdermal preparations of EPT are available natural progesterone can also be administered vaginally. Either progesterone derivatives or norethisterone derivatives can be used these may have different partial effects, and one or the other can be chosen for use accordingly. Combined estrogen-gestagen therapy is administered either sequentially, with at least ten days of gestagen administration per month, or continually in combination. A seven-day hormone-free interval is no longer recommended, as it often leads to a worsening of symptoms.

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    Perimenopause Vs Menopause Vs Postmenopause

    During perimenopause, menstrual periods become irregular. Your periods may be late, or you may completely skip one or more periods. Menstrual flow may also become heavier or lighter.

    Menopause is defined as a lack of menstruation for one full year.

    Postmenopause refers to the years after menopause has occurred.

    If Youve Been Diagnosed With Depression In The Past

    Having a history of depression makes it more likely youll experience an episode as you approach menopause. Talk to your doctor if your previous symptoms return or if you have new ones, including:

    • Persistent feelings of sadness, hopelessness or irritability
    • Low appetite or overeating
    • Overwhelming fatigue and lack of motivation
    • Loss of interest in activities previously enjoyed
    • Difficulty making decisions and absorbing information
    • Thoughts of suicide

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    Vaginal Dryness And Discomfort

    Vaginal dryness, itching, and discomfort may start during perimenopause and continue into menopause. A person with any of these symptoms may experience chafing and discomfort during vaginal sex. Also, if the skin breaks, this can increase the risk of infection.

    Atrophic vaginitis, which involves thinning, drying, and inflammation of the vaginal wall, can sometimes occur during menopause.

    Various moisturizers, lubricants, and medications can relieve vaginal dryness and associated issues.

    Learn more about atrophic vaginitis here.

    The Effect Of Hormone Therapy On The Quality Of Life

    Non-hormonal treatments for menopause: Mayo Clinic Radio

    Only a very small number of randomized, placebo-controlled trials have addressed this issue, yielding inconsistent findings. It should be pointed out that the quality of life was not defined uniformly. No improvement in the quality of life was found in the WHI study, yet smaller-scale placebo-controlled trials that were conducted over relatively short times did, in fact, reveal that HT improved the quality of life. The consensus paper of the North American Menopause Society takes the position that it is unclear whether HT improves the health-related quality of life of asymptomatic women .

    Urinary incontinence

    A meta-analysis of 50 small-scale trials led to the conclusion that ET can partially or completely relieve urinary incontinence, particularly when an overactive bladder is the cause.

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    What Happens During Menopause

    Natural menopause isnât caused by any type of medical or surgical treatment. Itâs slow and has three stages:

    • Perimenopause. This phase usually begins several years before menopause, when your ovaries slowly make less estrogen. Perimenopause lasts until menopause, the point at which your ovaries stop releasing eggs. In the last 1 to 2 years of this stage, estrogen levels fall faster. Many women have menopause symptoms.
    • Menopause. This is when it’s been a year since you had a period. Your ovaries have stopped releasing eggs and making most of their estrogen.
    • Postmenopause. These are the years after menopause. Menopausal symptoms such as hot flashes usually ease. But health risks related to the loss of estrogen increase as you get older.

    Fsh Lh Estrogen And Progesterone Levels

    Perimenopause is marked by changes in the secretion of gonadotropins. Urinary FSH, LH, estrogen, and progesterone levels were studied in a group of 6 cycling women, 47 years or older, for 6 months .7 Perimenopausal women had shorter cycles due to an attenuated follicular phase. Estrone excretion was greater in perimenopausal than in mid-reproductive-aged women, both overall and in the follicular and luteal phases of the cycle. Basal pregnanediol concentrations did not differ between perimenopausal and control groups however, overall they were lower in the perimenopausal group.

    FSH and LH levels, especially FSH, were elevated in the early follicular phase of the cycle. Mean follicular-phase FSH was elevated in perimenopausal women compared with mid-reproductive-aged women . LH was also elevated though less markedly. In contrast, age-appropriate postmenopausal women demonstrated little variation in gonadotropins and estrogen. FSH and LH were clinically elevated and estrone conjugate excretion was low .7

    The elevation of estrone conjugates suggests that although follicular numbers are decreasing, the ability of the ovary to produce estrogen continues. This finding is consistent with the observed increase in uterine myoma size, endometrial hyperplasia, and dysfunctional bleeding noted in these women, which are commonly attributed to anovulation.

    Tolu Oyelowo DC, in, 2007

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    What Are The Symptoms Of Menopause

    Every womans menopause experience is unique. Symptoms are usually more severe when menopause occurs suddenly or over a shorter period of time.

    Conditions that impact the health of the ovary, like cancer or hysterectomy, or certain lifestyle choices, like smoking, tend to increase the severity and duration of symptoms.

    Aside from menstruation changes, the symptoms of perimenopause, menopause, and postmenopause are generally the same. The most common early signs of perimenopause are:

    An estimated 75 percent of women experience hot flashes with menopause.

    Other common symptoms of menopause include:

    • follicle-stimulating hormone
    • luteinizing hormone

    One of the most notable changes is the loss of active ovarian follicles. Ovarian follicles are the structures that produce and release eggs from the ovary wall, allowing menstruation and fertility.

    Most women first notice the frequency of their period becoming less consistent, as the flow becomes heavier and longer. This usually occurs at some point in the mid-to-late 40s. By the age of 52, most U.S. women have undergone menopause.

    In some cases, menopause is induced, or caused by injury or surgical removal of the ovaries and related pelvic structures.

    Common causes of induced menopause include:

    Additional blood tests commonly used to help confirm menopause include:

    • vaginal atrophy
    • osteoporosis


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