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Menopause refers to permanent cessation of menstruation for 12 consecutive months. The ovaries cease functioning and it signals the end of a female’s reproductive period. It is generally natural biological process that usually occurs in women after 45 years of age.


Loss of the reproductive hormones estrogen and progesterone, produced by the ovaries, is the primary cause of menopause.

This depletion is usually a natural consequence of ageing and a result of depletion of eggs in the ovary. The decrease of estrogen is mainly responsible for menopausal symptoms such as hot flushes and mood changes.

In some cases, loss of these reproductive hormonesin ovulating women can result from the surgical removal of ovaries (oophorectomy). This results in immediate menopause without any transition phase.

Premature ovarian failure can also cause menopause. Seen in women usually under the age of 40, it occurs when the ovaries prematurely fail to produce normal levels of reproductive hormones. It is not known what causes premature menopause but genetic and autoimmune disorders are thought to be involved.

Medication used in chemotherapy and radiation used to treat cancer can damage the ovaries resulting in menopausal symptoms in ovulating women. However, it is inconclusive whether chemotherapy triggered menopause is permanent or temporary.

Risk Factors:

While menopause is a natural biological consequence of ageing, various factors can cause the early onset of menopause or menopausal symptoms in women.

Reproductive system disorders such as endometriosis and polycystic ovary syndrome can induce early menopause.

Cancer therapies and hysterectomies are also known to trigger premature menopause.

Besides these, smoking and a family history of early menopause make it more likely that one will start menopause at an earlier age.

Clinical Presentation

Menopause can be thought of as a transition through several stages. Pre-menopause is the period preceding the last menstrual cycle, perimenopause refers to the time immediately before and after the last menstrual cycle and finally menopause is the specific date post 12 months the last menstrual blood flow.

During this transition period, the most common symptoms are hot flushesand night sweats, weight gain and migraines.

Vaginal symptoms include vaginal dryness,irregular vaginal bleeding, itching and/or pain during sexual intercourse. Urinary symptoms include increased risk for urinary tract infections and urinary incontinence.

Menopausal women also experience emotional changes such as mood swings, irritability, anxiety, depression, insomnia, problems with concentration, fatigue and memory loss.

Studies have also shown that heart disease and osteoporosis are more of a risk for menopausal women because of their decreased estrogen levels.


The most accurate method to diagnose menopause is to observe the lack of menstrual blood flow for 12 months in women in the expected age range.

Hormone levels fluctuate widely between women, therefore blood tests are generally not considered a reliable method for diagnosing menopause. However under certain circumstances, physicians can prescribe certain tests to eliminate other causes of menopausal symptoms. For example, a test for the level ofthyroid stimulating hormone (TSH) in the blood is done to eliminate hypothyroidism as its symptoms are similar to that of menopause.


Since menopause is a natural stage in life for women, treatment usually deals with managing the changes associated with it.

Hormone (estrogen) replacement therapy (HRT): available in oral or transdermal form, may reduce the risk of heart disease and has also been shown to increase bone mass and reduce osteoporosis. Hot flushes are also treatable through HRT.It should be noted that HRT is not without its associated risks. While the risks vary depending on the type of hormone therapy, age and family medical history, in some studies HRT was found to increase incidence of heart disease, stroke, blood clots and breast cancer.

Bioidentical hormone therapy (BHT): Bioidentical hormones are man-made but chemically identical to those made in the body and are considered more “natural” and therefore safer over traditional HRT. However, no conclusive study exists to support this claim.

Vaginal estrogen: in the form of a cream or tablet can be used to treat vaginal dryness and other vaginal and urinary symptoms.

Oral contraceptive pills are recommended to treat irregular vaginal bleeding.

Selective serotonin reuptake inhibitors (SSRIs): in low doses are also prescribed for hot flushes as well as mood disorders. However, SSRIs are associated with side effects such as decreased libido and sexual dysfunction and should therefore be prescribed cautiously.

Other medication such as Gabapentin (used to treat seizures) can help reduce hot flushes. It is also effective against migraines.

Many menopausal women opt for alternative therapies because of the risks associated with hormone replacement therapy. Therapies like plant estrogen, Vitamin E, the herb Black cohosh, licorice, wild yams, acupuncture, natural progesterone creams have alltraditionally been used for treatment of menopausal symptoms,however their effectiveness remains inconclusive.

Lifestyle remedies: can be a viable supplement or even an alternative to medication for many women. Regular exercise, proper nutrition, stopping smoking, alcohol and caffeine can all reduce menopausal symptoms.