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What Is The Definition Of Menopause

Vaginal Dryness And Discomfort

Menopause – What is menopause?

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.

Bone Density And Calcium Mobilization

Menopause represents a vulnerable time for a womans skeletal health. Estrogen declines associated with menopause increase bone remodeling, leading to an imbalance between bone formation and bone resorption.153,154 This increase in bone remodeling persists over several years and becomes associated with an increased rate of bone loss.155,156 Early cross-sectional studies compared bone mineral density in pre-, peri-, and postmenopausal women and generally reported lower BMD in the peri- and post- menopausal periods.157159 However, these cross-sectional studies could not determine when bone loss began or the rates of bone loss during various phases of the transition.160

Other earlier studies showed bone loss in the perimenopausal period, but not in the premenopausal period.162 The first longitudinal study using state-of-the-art dual energy x-ray absorptiometry demonstrated significant change in femoral neck BMD, but not lumbar spine BMD among perimenopausal women.163 Finally, a longitudinal study of 75 women with a mean age of 46 years at baseline, who were followed for 9.5 years, showed that bone loss began about 23 years before menopause and ended 34 years after the last menses.164 The total loss in the spine and femoral neck was 10.5% and 5.3%, respectively, over the menopausal period. Results suggested that menopausal bone loss is a composite of loss caused by estrogen deprivation and age for the hip, but estrogen deprivation alone for the spine.164

How Long Does Menopause Last

The real answer to this question is forever because we will never get our periods back once they have stopped for 12 months. If you do get any vaginal bleeding after 12 months of stopping periods, then please get in touch with your GP. This is because it may be a sign of a change in the lining of the womb. Remember that it can be normal to experience light spotting or a bleed initially if you start HRT, but your doctor will guide you on this.

So, the real question you should be asking is: how long do the symptoms of menopause last? This relates to symptoms that we are conscious of such as night sweats and hot flushes. These are called vasomotor symptoms and last on average two years.

It is important to understand all menopause information and, in particular, that relating to the symptoms you may be experiencing and the queries you have about what you can expect after menopause.

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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.

What Conditions Cause Premature Menopause

Definition Of Menopause

Your genes, some immune system disorders, or medical procedures can cause premature menopause. Other causes include:

  • Premature ovarian failure. When your ovaries prematurely stop releasing eggs, for unknown reasons, your levels of estrogen and progesterone change. When this happens before youâre 40, it’s called premature ovarian failure. Unlike premature menopause, premature ovarian failure isnât always permanent.

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Do All Menopausal Women Experience A Decrease In Sexual Desire

Not all women experience a decreased sexual desire. In some cases, its just the opposite. This could be because theres no longer any fear of getting pregnant. For many women, this allows them to enjoy sex without worrying about family planning.

However, it is still important to use protection during sex if not in a monogamous relationship. Once your doctor makes the diagnosis of menopause, you can no longer become pregnant. However, when you are in the menopause transition , you can still become pregnant. You also need to protect yourself from sexually transmitted infections . You can get an STI at any time in your life.

Why Does Menopause Happen

Natural menopause menopause that happens in your early 50s and is not caused by surgery or another medical condition is a normal part of aging. Menopause is defined as a complete year without menstrual bleeding, in the absence of any surgery or medical condition that may cause bleeding to artificially stop As you age, the reproductive cycle begins to slow down and prepares to stop. This cycle has been continuously functioning since puberty. As menopause nears, the ovaries make less of a hormone called estrogen. When this decrease occurs, your menstrual cycle starts to change. It can become irregular and then stop. Physical changes can also happen as your body adapts to different levels of hormones. The symptoms you experience during each stage of menopause are all part of your bodys adjustment to these changes.

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How Can Symptoms Be Handled

Being informed about what may happen during the menopause transition is a very good starting point.

Women are encouraged to pay attention to their health, including quitting smoking, eating well, exercising regularly and incorporating some relaxation techniques. Self-management strategies such as carrying a fan, dressing in layers, always having a cool drink and a facial water spray can be helpful. Avoiding spicy foods, caffeine and alcohol will also reduce flushing.

Some women may find relief from menopausal symptoms with herbal or alternative remedies, however most have not been studied or shown to be of benefit scientifically and some, like black cohosh, have been occasionally linked to serious side effects. Bioidentical hormones mixtures of hormones supplied by compounding chemists may be touted as beneficial and more natural than menopause hormone replacement therapy but there is inadequate evidence for their safety and effectiveness .

Doctors may prescribe other drugs to relieve symptoms, such as anti-depressants , gabapentin, and clonidine. .

Symptoms Of The Menopause

Definition of Menopause

Most women will experience menopausal symptoms. Some of these can be quite severe and have a significant impact on your everyday activities.

Common symptoms include:

Menopausal symptoms can begin months or even years before your periods stop and last around 4 years after your last period, although some women experience them for much longer.

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Central Nervous System And Menopause

The association between estrogen and memory function is an intriguing area of research. Normal aging itself induces a decline in certain cognitive capabilities, and a lack of estrogen may contribute to this process. If this is the case, postmenopausal estrogen therapy may be able to preserve this function and slow or even prevent decline in certain cognitive functions.

An inherent difficulty in this area involves the limitations of objective cognitive testing for functions such as memory. Postmenopausal women receiving estrogen therapy have shown better performance on memory testing than postmenopausal control subjects not receiving estrogen therapy. The effect of estrogen is to slow the decline of preserved memory function. Womens Health Initiative data do not show improved cognitive function in women taking either hormone therapy or estrogen therapy.

Current data suggest that Alzheimer disease is more common in women than in men, even when the longer average lifespan of women is taken into account, because AD is primarily an age-related condition. In earlier studies, estrogen therapy appeared to reduce the relative risk of AD or to delay its onset. Estrogen therapy has not been shown to improve cognitive function in patients with AD; it cannot reverse previous cognitive decline and therefore has no role as a sole treatment modality in AD. WHI data support this view.

What Is Premature Menopause

Menopause, when it occurs between the ages of 45 and 55, is considered “natural” and is a normal part of aging. But, some women can experience menopause early, either as a result of a surgical intervention or damage to the ovaries . Menopause that occurs before the age of 45, regardless of the cause, is called early menopause. Menopause that occurs at 40 or younger is considered premature menopause.

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Ethics Approval And Consent To Participate

Ethical approval for the study was obtained from the Ethics Review Committee of the University of Sri Jayewardenepura and Kristianstad University, Sweden. The procedures followed were in accordance with the ethical standards of the Declaration of Helsinki of the World Medical Association. All participants gave written informed consent before commencement of the data collection.

How Do I Know If Changes In My Periods Are Normal Perimenopausal Symptoms Or Something To Be Concerned About


Irregular periods are common and normal during perimenopause . But other conditions can cause abnormalities in menstrual bleeding. If any of the following situations apply to you, see a doctor to rule out other causes.

  • Your periods are changing to become very heavy, or accompanied by blood clots.
  • Your periods last several days longer than usual.
  • You spot or bleed after your period.
  • You experience spotting after sex.
  • Your periods occur closer together.

Potential causes of abnormal bleeding include hormonal imbalances, hormonal treatments, pregnancy, fibroids, blood-clotting problems or, rarely, cancer.

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Can Menopause Be Treated

Menopause is a natural process that your body goes through. In some cases, you may not need any treatment for menopause. When treatment for menopause is discussed, its about treating the symptoms of menopause that disrupt your life. There are many different types of treatments for the symptoms of menopause. The main types of treatment for menopause are:

It is important to talk to your healthcare provider while you are going through menopause to craft a treatment plan that works for you. Every person is different and has unique needs.

Contraception In The Peri

A womans fertility declines naturally in her 40s and the risk of pregnancy after the age of 50 years is estimated at less than one per cent but women may ovulate twice in a cycle and as late as three months before the final period. Women are advised to keep using contraception until two years after their last period if they experience the menopause under the age of 50, and for one year after the last period if aged 50 years or more2. Women using combined oral contraception ;are generally advised to cease by the age of 51 years and switch to a non-hormonal or progestogen-only method. The risks of ethinyl oestradiol-containing methods increase with age, especially if the woman is a smoker over the age of 35 .

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Contextual Differences In The Experience Of Menopause

Attitudes toward menopause differ by gender, and are influenced by many contextual factors, including the attitude and response of health care providers. Additionally, the way menopausal symptoms are experienced, and the preferred management approach to address symptoms differs widely by context.

Attitudes Toward Menopause

The way menopause is perceived and therefore experienced and managed depends to a large extent on the social and cultural context in which women live . Although research points to menopause as a physiological process, some people perceive it as a disease process, especially in settings where people are ill-informed about menopause and how and why it occurs.

Attitudes of Women Toward Menopause

In studies among women in West Bengal, India, and Bahrain, researchers found that postmenopausal women had a more positive attitude toward menopause than their perimenopausal counterparts . A majority of highly educated Asian female teachers residing in Pakistan reported a positive attitude toward menopause . A qualitative study conducted in Singapore also reported a generally positive attitude toward menopause . One study among women and their spouses in Turkey reported that, in general, both groups had a positive attitude toward menopause .

Attitudes of Men Toward Menopause
Attitudes of Providers

Common Symptoms Associated with Menopause

Management of Menopause

Nonhormonal/Behavioral, Including Self-Care Strategies
Alternative Treatments/Natural Remedies

Are There Any Risks Related To Hormone Therapy

What is the menopause?

Like most prescribed medications, there are risks for hormone therapy. Some known health risks include:

  • Endometrial cancer .
  • Gallstones and gallbladder issues.

Going on hormone therapy is an individualized decision. Discuss all past medical conditions and your family history with your healthcare provider to understand the risks versus benefits of hormone therapy for you.

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The Cost Of Menopause

The need for more education on menopause in the workplace has been well documented. An exhaustive 2017 research report by Brewis and colleagues looked at 104 English language publications on the effects of menopause transition on womens economic participation in the United Kingdom from 1990 to 2016 . The studies surveyed found an increase in population of older employed women in the workforce, highlighting the reality that a larger proportion of the workforce will have to cope with menopause symptoms while working. Menopause is not well understood by the general population and workplace interventions are not commonly in place. Additionally, attitudes of colleagues and managers can severely impact a womans QoL. Gendered ageism is a significant problem that requires organizational culture changes. Studies have shown both positive and negative effects of menopause on working women, and the positive variations may be due to job type, especially among women in more senior positions. Several areas exist where more data are needed, including studies that can contribute to how the experience of the menopause transition can affect the labor force. Data from these studies will allow a recognition of the potential productivity losses which organizations will incur if they do not make use of the full array of experience, skill and knowledge possessed by older female workers .

Breast Cancer And Menopause

Estrogen therapy is known to benefit postmenopausal women in a multitude of ways, mostly through the relief of vasomotor symptoms associated with postmenopause. Estrogen is also beneficial for the prevention and treatment of osteoporosis.

Much controversy exists about the use of estrogen and breast cancer. Some studies show an increased risk of breast cancer with postmenopausal estrogen use; others show a decrease. A possible link to cancer is also suggested by the finding that breast cancer risk is increased in women with an earlier age at menarche and a later age at menopause. However, a reduction in risk is observed with early age at pregnancy and the interruption of menstrual hormonal changes. The role of estrogen in the development of breast cancer continues to be studied.

In the Womens Health Initiative , the incidence of breast cancer increased in the estrogen-plus-progestin versus placebo arm of the study ; however, the incidence of breast cancer decreased in the estrogen-only versus placebo arm of the study .

Additional follow-up in patients from the WHI suggested similar results: Breast cancer incidence and mortality were increased in the estrogen-plus-progestin group as compared with the placebo group. The role of combined estrogen-plus-progesterone therapy continues to be puzzling in the development of breast cancer.;

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Treatments For Menopausal Symptoms

Your GP can;offer treatments and suggest lifestyle changes if you have severe menopausal symptoms that interfere with your day-to-day;life.

These include:

Your GP may refer you to a menopause specialist if your symptoms do not improve after trying treatment or if you’re unable to take HRT.

How Is Premature Menopause And Primary Ovarian Insufficiency Treated


Management of the condition can vary depending on why menopause started earlier than normal. Given the health risks associated with early menopause, hormone replacement therapy is routinely recommended to all women with premature menopause or primary ovarian insufficiency, unless there is a compelling reason it cant be used. There is a lot of confusion about the safety of hormone therapies. Many of the risks of hormone therapy used after natural menopause are not thought to apply to women who have premature menopause. It is important to discuss the pros and cons of hormone therapy with your doctor. Some healthcare providers have additional certification in the management of menopause, and these providers will be a valuable resource when receiving conflicting information about the safety of hormone therapy.

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Physical Symptoms Of Menopause

Symptoms commonly reported by peri- and post-menopausal women include hot flushes and night sweats, bodily aches and pains, dry skin, vaginal dryness, loss of libido, urinary frequency, and sleeping difficulties. Some women may have unwanted hair growth, thinning of scalp and pubic hair and skin changes. Not everyone finds the symptoms bothersome but about 60% of women will have mild symptoms for around 4-8 years. Twenty per cent of women will have no symptoms at all while another 20% will be severely affected, with symptoms continuing into their 60s or later3.;

Now that women live around one third of their lives after menopause, optimizing physical and mental health during this period is becoming more important. ;


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