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Menopause: Overview and Risk Factors

Menopause is a normal condition of the female life cycle, not a disease or a diagnosis. It can, however, be accompanied by symptoms and mood changes, all of which are temporary.

At menopause, a woman's ovaries stop producing eggs, her body produces less estrogen and progesterone, and menstrual periods become less frequent, eventually stopping altogether. The average age of menopause in the United States is 51. Menopause that occurs beyond age 56 is considered late menopause.

A transition generally occurs for several years before the cessation of periods. During this time, the menstrual cycle is often erratic, resulting in irregular periods, heavy breakthrough bleeding, hot flashes, and vaginal dryness.

Once the ovaries cease producing eggs, estrogen production declines, which results in the clinical symptoms of menopause.

Hot flashes are the most common initial menopause symptom, occurring to some extent in up to two–thirds of North American women. A sensation of heat and perspiration may last several minutes and is often preceded or followed by chills and shivering. In some cases, heart palpitations occur as well. 

Vaginal dryness, due to the decrease in estrogen stimulation of the vagina and urethra, is common and may cause painful sexual intercourse.

Psychological symptoms are also common, including depression, anxiety, irritability, fatigue, and difficulty concentrating. These symptoms may reflect the hormonal shifts or may be related to the sleep disturbances that are commonly associated with hot flashes. In many cases, the psychological symptoms can be improved by any measures that improve sleep.

Risk Factors

About 40 percent of North American women seek treatment for menopausal symptoms. There are some suggestions that African–American women are less likely to report symptoms, compared with Caucasians. Risk factors for the development of menopausal symptoms are likely related to a combination of environmental, lifestyle, and social factors. There is not consistent evidence that weight, health status, or hysterectomy are risk factors. Symptoms appear to be significantly less common in Asia, compared with North America, a difference that has been attributed to diet.


Menopause: Assessment and Treatment >>