Menopause

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Traditionally, the natural menopause is diagnosed 12 months after a woman’s last menstrual period.
However, this definition is not inclusive of women with amenorrhoea due to other causes prior to the natural menopause transition. For example, women with hysterectomy, a past history of endometrial ablation or women using hormone treatments such as the progestogen only pill, combined contraceptive pill or long acting reversible contraceptive methods.
A more broadly applicable definition therefore is the final cessation of ovarian function with loss of reproductive hormones.

The menopause is associated with menopausal symptoms in more than 75% of women.
The duration and intensity of symptoms varies significantly between patients.
Natural menopause occurs because the ovaries gradually become less responsive to gonadotropins, due to declining oocyte numbers, which in turn leads to reduced levels of oestrogen and progesterone.
The low levels of oestrogen are no longer sufficient to stimulate the endometrium, leading to amenorrhea.

The average age of menopause is 50–51 years in Caucasian women but can be lower in other ethnicities.
When menopause occurs in women aged 40–44 years, this is termed an early menopause.
When menopause occurs in women <40 years, this is termed premature ovarian insufficiency.
When menopause is caused by surgical removal of the ovaries, this is termed a surgical menopause.
When menopause is caused by treatments or medications, this is termed an induced menopause.

Note

For information on the assessment and investigation of post-menopausal bleeding see assessment section.

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