Menopause and Climacteric Definitions

Menopause

• Menopause is the permanent cessation of menstruation due to failure of ovarian follicular development in the presence of adequate gonadotropins.
• Diagnosis of menopause is established when menstruation stops for 12 months in absence of an organic or a pathological cause.

Climacteric

• Climacteric is the physiological period in a woman's life during which ovarian function regresses.
• Menopause is only one aspect of the climacteric, during which time women undergo endocrine, somatic, and psychological changes that span several years.

Stages of Menopause

• Pre-menopause
• Climacteric
• Post-menopause

Hormonal Changes After Menopause

• FSH and LH are elevated >25 IU/L
• Estrogen decreases
• Decrease progesterone and inhibin
• Testosterone is relatively increased

Clinical Changes

• Menstrual changes
• Vasomotor instability
• Osteoporosis
• Cardiovascular changes
• Genitourinary atrophy
• Psychological changes
• Skin collagen changes

Menstrual Changes

• Most women note a gradual tapering in both amount and duration of flow
• A minority of women have more frequent and heavier bleeding
• Abrupt cessation of menses is fairly rare

Vasomotor Instability (Hot Flashes)

• Most common and troublesome symptoms for women at the climacteric
• Obese women are less troubled by hot flashes than thin women
• 75% of women experience hot flashes within 3 months of menopause
• Hot flashes lessen in frequency and intensity with advancing age

Cardiovascular Changes

• Estrogen is a cardio-protective
• Estrogen increases HDL and decreases LDL
• Risk of cardiovascular disease increases after menopause

Genitourinary Atrophy

• Vaginal walls become pale due to diminished vascularity and thin
• Vaginal epithelial cells contain less glycogen, leading to loss of protective mechanism
• Vagina loses its rugae and becomes shorter and inelastic

Symptoms of Genitourinary Atrophy

• Dyspareunia
• Vaginitis
• Vaginal dryness
• Dysuria
• Urgency and frequency of urination
• Supra-pubic pain

Psychological Changes

• Irritability and anxiety
• Depression
• Lack of concentration
• Change of libido
• Alzheimer's disease

Skin Collagen Changes

• Up to 30% of skin collagen can be lost during the first five years of menopause
• Changes can be prevented and reversed with Estrogen Replacement Therapy (ERT)

Osteoporosis

• Reduction of bone mass density with micro-architectural alteration and increase bone fragility
• Imbalance between osteoclastic and osteoblastic activity (defective remodeling)

Risk Factors for Osteoporosis

• Unchangeable factors:
  • Gender
  • Heredity
  • Age
  • Fracture history
  • Medical conditions (e.g. hyperthyroidism, parathyroidism)
  • Medications for chronic diseases (e.g. steroids)
• Changeable factors:
  • Calcium consumption
  • Vitamin D intake
  • Quit smoking or vaping
  • Alcohol consumption
  • Physical activity
  • Posture
  • Low body weight (BMI < 20)
  • Some medications

Complications of Osteoporosis

• Fractures
• Most common sites of fracture are the vertebrae, femur neck, and distal radius
• One-third of women will suffer vertebral fracture after 65 years of age and hip fracture by age 90

Learn about the definitions of menopause and climacteric, including the diagnosis and symptoms of menopause. Understand the physiological period of ovarian function regression in a woman's life.