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Menopause For a woman, the reproductive period is demarcated
by two main events: the menarche and the menopause. Traditionally,
menopause has been defined as the point in time of the last
menstrual bleeding in a woman's life. In most industrialised
countries, natural menopause occurs on average around the age
of 51, but there is a large variation in age at natural menopause
(mean age: 51 yrs; range: 39 - 59 yrs). Menopause and
last ovulatory bleeding are not identical in many cases. Although
a menopause age of 57 and over is regularly reported, the age
of the oldest woman becoming pregnant in a natural way ever
reported was 56 years (Guiness Book of Records). By definition,
menopause occurring before the age of 40 is called precocious
or premature menopause. Today, the term premature ovarian failure
(POF) is also used. The incidence of premature menopause is
approximately 1%. Typically, the date of menopause is
established in retrospect, following a full year of amenorrhea.
In a woman around 50 years of age, periods of secondary amenorrhea
shorter than 1 2 months do not guarantee that menopause has
been passed. Although the "one Year amenorrhea"-criterium
seems primitive, all other methods of diagnosing menopause earlier
are less accurate. It should be remembered that elevated FSH
and LH levels and severe vasomotor symptoms could be present
long before menopause is reached, while even ovarian biopsies
without follicles can be false-negative. In some instances it
can be difficult to establish the moment of menopause accurately,
for instance after hysterectomy or in case of OC use.
Post-menopause The post-menopause is the period of life
after the menopause. Increasingly, the term menopause is used
in a different sense to its original meaning. The term menopause
then refers to the total postmenopausal period and thus is synonymous
to the term post-menopause. The World Health Organisation defines
menopause as the permanent cessation of menstruation resulting
from the loss of ovarian follicular activity. Early menopause
is a term sometimes used to denote the first few Years directly
after menopause, in which still considerable, endogenous oestradiol
activity can be present. Late menopause is the period thereafter.
The peri-menopause The peri-menopause can be defined as
the period of time around the menopause in which marked menstrual
cycle changes occur, often in conjunction with vasomotor symptoms
and in which no period of 1 2 consecutive months of amenorrhea
has Vet occurred. The median length of the perimenopause is
4 to 5 Years (range: 1 - 9 yrs).
The climacteric The term climacteric refers to the period
of menopausal transition. During this period, many profound
changes take place in a woman's life (Table II). Many, but not
all, are directly related to the ageing process of the ovaries.
Body changes and mood swings are intermingled with changes in
family and social environment. All these factors together can
have a profound influence on the psycho-social functioning and
general well-being of the climacteric woman. There is great
variability in climacteric complaints and symptoms, both between
cultures as well as between individuals within a culture. In
our Western society, for many women the menopausal experience
with transcient climacteric effects is minimal, for others the
impact is severe. Climacteric and perimenopausal women should
not be regarded as a homogeneous group.
| Table
II. The climacteric: the period of transition from fertility
to sterility |
| |
transition
from |
via |
to |
|
reproductive capacity |
fertility |
subfertility |
sterility |
|
Ovarian folliculogenesis |
regular recruitment and maturation |
accelerated loss of follicles after 38 yrs of age |
total depletion of follicles |
|
ovarian cycles |
ovulatory |
Increasingly anovulatory with luteal phase defects |
anovulatory |
|
menstrual periods |
regular periods |
initial shortening of the cycle, thereafter longer irregulary
cycles |
amenorrhea |
|
hormonal profile |
ovulatory cycle profile |
Increase in early follicular FSH; often low progesterone
levels in second half; decreasing inhibin; LH, E2 and
androgen levels stay long stable |
hypogonadotropic, hypooestrogenic status with low androgen
levels and undetectable inhibin |
|
needs, complaints and risks |
contraception needs |
Contraception needs and climacteric complaints |
increased risk of osteoporosis and cardiovas. disease |
|
family life |
active family life; professional career |
"empty
nest" situation; midlife crisis |
re-orientation; re-integration |
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