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menopause (mĕnˈəpôz) or climacteric (klīmăkˈtərĭk, klīˌmăktĕrˈĭk), transitional phase in a woman's life when the ovaries stop releasing eggs, ovarian production of estrogen and other hormones tapers off, and menstruation ceases. It results from declining ovarian function due to aging of the ovaries and is usually a gradual process. In the United States, natural menopause occurs at age 51 on average. Premature menopause (due to premature aging of the ovaries, debilitating disease, or infection) and artificial menopause (due to destruction of the ovaries by surgery, irradiation, or purposeful hormone therapy, as in severe premenstrual syndrome) may occur much earlier.
Menopause may pass with no signs other than cessation of menstruation, or it may be accompanied by menstrual changes (heavy or erratic periods), night sweats, hot flashes, and vaginal dryness. There is some debate as to whether emotional symptoms and “mood swings” are any more common during menopause than at any other age. Lower levels of estrogen following menopause may be accompanied by a variety of physical changes. For example, the risk of osteoporosis, in which the bones lose elasticity and become brittle, increases. In addition, levels of high-density lipoproteins (HDLs) decrease as low-density lipoproteins (LDLs) increase, arteries lose elasticity, and more body weight is redistributed to the waist area—all heightening the risk of heart disease. Other possible estrogen-related changes include stress incontinence due to loss of muscle tone in the pelvis, loss of elasticity in the skin, and hair thinning.
Estrogen replacement therapy (ERT) is a controversial treatment introduced in the 1970s for bodily changes that occur in menopause; beginning in the 1980s progestins were added to reduce the risk of uterine cancer. Although ERT eases hot flashes and other physical changes and appears to decrease the risk of osteoporosis, it has been linked to increases in breast cancer, heart disease, and stroke.
Other approaches to dealing with the physical changes include exercise to help circulation, increase bone density and HDL levels, and lower stress; lubricants for vaginal dryness; avoidance of smoking and excess alcohol; and dietary changes limiting protein and fat and increasing fiber and calcium. Natural remedies such as vitamins E and B6 or ginseng and other foods that contain or mimic estrogen are sometimes recommended, but research as to their efficacy has been limited.
See also uterus.
See publications of the National Institute of Child Health and Human Development; J. E. Huston and L. D. Lanka, Perimenopause: Changes in a Woman's Health after 35 (1997); Boston Women's Health Book Collective, Our Bodies, Ourselves for the New Century (1998).
(medicine), the transitional period from sexual maturity to middle age.
In women the climacteric is manifested by a disturbance in the regularity of the menstrual cycle until it ceases completely, which signals the onset of a new period in a woman’s life, the menopause. The climacteric generally begins between the ages of 45 and 54, usually at about 47 years of age, and continues for an average of 15–18 months. If the onset of the climacteric is premature (prior to the age of 40) it is called an early climacteric; a late climacteric is one that occurs after the age of 55. An early climacteric is caused by a primary deficiency of the ovaries (associated with the late onset of menstruation, at 17–18 years) and a hard life; infectious diseases, emotional shock, and constitutional and genetic predisposition are also significant. A late climacteric usually occurs in women who for some reason have congestion in the small pelvis or who have fibromyomas of the uterus. In some women menstruation ceases suddenly, in others gradually. During the climacteric period uterine hemorrhage may occur, caused by impairment in the functioning of the ovaries and in the formation of the corpus luteum.
The climacteric results from complex changes in the entire system regulating cyclic changes in the female body, including the central nervous system (hypothalamus, diencephalon, hypophysis) and the ovaries. In the ovaries maturation of the follicles and release of ova (ovulation) cease. However, sometimes ovulation continues for some time after cessation of menstruation. Production of hormones that regulate cyclic changes continues for a number of years after menstruation has ceased.
For more than half of all women the climacteric proceeds smoothly and is not accompanied by pathological symptoms. In lingering or late climacteric, in particular, hemorrhages may occur (sometimes caused by a tumor), as well as various disturbances known as the climacteric syndrome. The syndrome often occurs in early spring (February-March) and is apparently due to spring hypovitaminosis, fatigue after the winter, and the decrease in solar radiation. The chief complaint is “hot flashes,” sudden reddenings of the face, neck, breast, and nape, accompanied by a sensation of heat. This state continues for 2 or 3 minutes and usually occurs in the evening; especially distressing are night flashes. During the flashes the woman may perspire freely. Other symptoms include nervousness, irritability, headaches, insomnia, phobia, and depression. During the climacteric some women experience increased blood pressure and sometimes chest pains; there may also be pains in the knee joints, or, more rarely, in the finger joints (endocrine arthritides). Since they result from the age-connected reorganization of the body, these unpleasant symptoms often pass without treatment. When a climacteric syndrome causes medium to severe distress, treatment is necessary, including measures for strengthening the whole body (good health habits and diet, particularly when there is a tendency to obesity; plenty of vitamins A, B, and E), galvanization, hydrotherapy (coniferous baths), and hormone therapy (estrogens, androgens, or combinations of both).
Prevention of pathological manifestations includes good health habits and exercise.
In men the climacteric usually begins between the ages of 50 and 60; it is less pronounced but lasts longer. Symptoms include impairment of the functioning of the autonomic nervous system, cardiovascular and hormonal disturbances, insomnia, weakening of the memory, phobia, and a decrease in work capacity. Dizziness, fainting, a sensation of pulsation in the head, and heat flashes in the head and face may also occur. Sometimes there are chest pains, and the blood pressure may rise. Sexual desire and potency decrease, although not always. Treatment of the climacteric syndrome consists in the prolonged use of hormonal preparations (androgens).
REFERENCESBaranov, V. G., I. Iu. Podol’skaia, and I. G. Rozovskaia. “Funktsiia kory nadpochechnikov u zhenshchin v period stareniia i klimaksa.” Problemy endokrinologii i gormonoterapii, 1960, no. 3, pp. 95–103.
Kvater, E. I. Gormonal’naia diagnostika i terapiia v akusherstve i ginekologii, 2nd ed. Moscow, 1961.
Malinovskii, M. S., and E. D. Svet-Moldavskaia. Klimakterii i menopauza. Moscow, 1963. (Bibliography.)
Fiziologiia i patologiia klimakteriia zhenshchiny. Leningrad, 1965.
Vikhliaeva, E. M. Klimaktericheskii sindrom i ego lechenie. Moscow, 1966.
V. A. POKROVSKII