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ity of resumption of menstruation after 12 months of amenorrhea is vanishingly small. 29,30 Much confusion has been caused by differing definitions used in relationship to changing ovarian status. Definitions were provided by the World Health Organization (WHO) Scientific Group on Research on the Menopause in the 1990s. 9 More recently, these definitions and others were considered by the Council of Affiliated Menopause Societies (CAMS) of the International Menopause Society (IMS). The only change recommended to the WHO definitions was the inclusion of the term “climacteric,” considered by many clinicians to be descriptive of this phase of life. The list of menopauserelated definitions given below was approved by the IMS in October 1999, in Yokohama, Japan. 31 FIGURE 2–5 30 Climacteric Menopausal transition Perimenopause Mean age 51 years 1 year later Final menstrual period (FMP) Menopause TERMS SOURCE Menopause (natural menopause) WHO The term “natural menopause” is defined as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. Natural menopause is recognized to have occurred after 12 consecutive months of amenorrhoea, for which there is no other obvious pathological or physiological cause. Menopause occurs with the FMP, which is known with certainty only in retrospect a year or more after the event. An adequate biological marker for the event does not exist. Relationships Between Different Time Periods Surrounding the Menopause Postmenopause
Perimenopause WHO The term “perimenopause” should include the period immediately prior to the menopause (when the endocrinological, biological, and clinical features of approaching menopause commence) and the first year after menopause. Menopausal transition WHO The term “menopausal transition” should be reserved for that period of time before the FMP when variability in the menstrual cycle is usually increased. Climacteric IMS This phase in the aging of women marks the transition from the reproductive phase to the nonreproductive state. This phase incorporates the perimenopause by extending for a longer variable period before and after the perimenopause. Climacteric syndrome IMS The climacteric is sometimes, but not necessarily always, associated with symptomatology. When this occurs, it may be termed the “climacteric syndrome.” Premenopause WHO The term “premenopause” is often used ambiguously to refer to the 1 or 2 years immediately before the menopause or to refer to the whole of the reproductive period prior to the menopause. The group recommended that the term be used consistently in the latter sense to encompass the entire reproductive period up to the FMP. Postmenopause WHO The term “postmenopause” is defined as dating from the FMP, regardless of whether the menopause was induced or spontaneous. Premature menopause WHO Ideally, premature menopause should be defined as menopause that occurs at an age more than two standard deviations below the mean estimated for the reference population. In practice, in the absence of reliable estimates of the distribution of age at natural menopause in populations in developing countries, the age of 40 years is frequently used as an arbitrary cutoff point, below which menopause is said to be premature. Induced menopause WHO The term “induced menopause” is defined as the cessation of menstruation, which follows either surgical removal of both ovaries (with or without hysterectomy) or iatrogenic ablation of ovarian function (e.g., by chemotherapy or radiation). Figure 2–5 shows the relationships between different time periods surrounding the menopause. 4. PHYSIOLOGY The process of the menopausal transition appears to take about a decade. The earliest signs of this transition are (1) shorter menstrual cycles by 2–3 days and (2) infertility. After birth, the number of oocytes continuously decreases. At puberty, 1 million oocytes are left. 32 This number decreases to 0.3 million by the age of 20 years. 32 Menopause is marked by the exhaustion of the ovarian supply of oocytes. 33 Although only approximately 400 follicles or less than 0.01 percent of all oocytes proceed through ovulation between menarche and menopause, 33,34 long-standing amenorrhea or the prolonged intake of a contraceptive pill does not seem to postpone menopause. 13 Reduced fertility due to the aging process of the oocytes and to abnormal follicular maturation is the first sign of ovarian aging. After the age of 40, about 30–50 percent of all cycles show an abnormal basal temperature. 35,36 Two to eight years before menopause, the incidence of luteal insufficiency and anovulatory cycles increases, 37 resulting in a higher incidence of persisting follicles and dysfunctional bleeding. Shorter menstrual cycles appear to be detectable at about age 38–40. 38,39 The subtle but common shortening of the intermenstrual interval is clinically valuable, as it seems to be predictive of other perimenopausal changes. 31
Page 1: National Heart, Lung, and Blood Ins
Page 4 and 5: CHAIRS AND EDITORS Chair and Editor
Page 6 and 7: Anne McTiernan, M.D., Ph.D. Associa
Page 8 and 9: Lenore Manderson, Ph.D. Director an
Page 10 and 11: Michael Mendelsohn, M.D. Director,
Page 13 and 14: TABLE OF CONTENTS Preface XIII 1 Ex
Page 15 and 16: PREFACE Women’s health and menopa
Page 17 and 18: CHAPTER 1: EXECUTIVE SUMMARY Nanett
Page 19 and 20: TABLE 1-1 Evidence Categories Evide
Page 21 and 22: TABLE 1-2 (continued) Possible Bene
Page 23 and 24: symptom measures, cultural factors,
Page 25 and 26: 5. PHYSIOLOGICAL ROLE OF ESTROGEN A
Page 27 and 28: The atherogenic risk profile of old
Page 29 and 30: • Hormone replacement therapy: Fi
Page 31 and 32: tion of the remaining ridge in area
Page 33 and 34: 9.3.1 Interventions • In many cas
Page 35 and 36: Parkinson’s disease, no overall p
Page 37 and 38: TABLE 1-3 (continued) Sexuality •
Page 39 and 40: CHAPTER 2: THE MENOPAUSE AND AGING
Page 41 and 42: oped and are less prepared to addre
Page 43 and 44: FIGURE 2-4 Diabetes Mellitus. Estim
Page 45: Sarcopenia, defined as reduced musc
Page 49 and 50: decrease about 2 years before the F
Page 51 and 52: 4.3 Menstrually Defined Menopausal
Page 53 and 54: to be under stress and to hold part
Page 55 and 56: 21 Brincat MP. Hormone replacement
Page 57 and 58: 62 Orentreich N, Brind JL, Rizer RL
Page 59 and 60: CHAPTER 3: SYMPTOMS AND THE MENOPAU
Page 61 and 62: women who may have reached natural
Page 63 and 64: numb-tingling feelings, headaches,
Page 65 and 66: (47 percent), problems sleeping (39
Page 67 and 68: FIGURE 3-2 Proportion of Women Both
Page 69 and 70: tomized hypogonadotropic women expe
Page 71 and 72: 5.1 Exercise It has been suggested
Page 73 and 74: to consume 20-150 mg/day of isoflav
Page 75 and 76: REFERENCES 1 Stewart AL, Hays RD, W
Page 77 and 78: 48 Avis NE, Crawford SL, McKinlay S
Page 79: 92 Albertazzi P, Pansini F, Bonacco
Page 82 and 83: Hällström wrote that the psycholo
Page 84 and 85: countries. Perhaps, as the authors
Page 86 and 87: Beyene used a systematic ethnograph
Page 88 and 89: ange of variables, such as genetic
Page 90 and 91: REFERENCES 1 Gannon L, Ekstrom B. A
Page 92 and 93: 47 George T. Women in a south India
Page 94 and 95: 9. Estrogen and inhibins produced b
Page 96 and 97:
HRT) display tissue-selective estro
Page 98 and 99:
a partial agonist. In contrast, wit
Page 100 and 101:
3. UROGENITAL TRACT ERα and ERβ a
Page 102 and 103:
4. BONE: DEVELOPMENT AND HOMEOSTASI
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in response to estrogen. 106,105 In
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lation of sleep, motor behavior, an
Page 108 and 109:
7. HORMONE REPLACEMENT THERAPY: TRA
Page 110 and 111:
REFERENCES 1 Jensen EV, Jacobsen HI
Page 112 and 113:
40 Power RF, Mani SK, Codina J, Con
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83 Oursler MJ, Pederson L, Fitzpatr
Page 116 and 117:
125 Gabrielsson BG, Carmignac DF, F
Page 118 and 119:
169 Renier MA, Vereecken A, Buytaer
Page 120 and 121:
FIGURE 6-1 Structural features of E
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ound, the conformation of the recep
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with extremely potent estrogenic ac
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Its potency as an antiestrogen was
Page 128 and 129:
The observation that the degree of
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findings were remarkable because a
Page 132 and 133:
Recently, the use of phage display
Page 134 and 135:
20 Crawley G. Non steroidal estroge
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65 Qu Q, Zheng H, Dahllund J, et al
Page 138 and 139:
in their survey of postmenopausal w
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where over half the world’s popul
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The Danish study of Koster and Gard
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Many studies of sexual interest in
Page 146 and 147:
7. ASSESSING SEXUAL ACTIVITY Clinic
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None of these studies evaluated the
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estrogen-androgen group during the
Page 152 and 153:
REFERENCES 1 Sarrel PM, Whitehead M
Page 154 and 155:
52 Utian WH. The true clinical feat
Page 156 and 157:
140
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outes of administration and differe
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FIGURE 8-2 Change in Age-Adjusted D
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fied as overweight or obese. 32 The
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TABLE 8-1 148 Guide to Risk Reducti
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TABLE 8-1 (continued) 150 Recommend
Page 168 and 169:
TABLE 8-1 (continued) 152 Recommend
Page 170 and 171:
Interesting differences in atherosc
Page 172 and 173:
similar effects in both patients wi
Page 174 and 175:
a lowering of triglycerides, 140 an
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may account for a substantial propo
Page 178 and 179:
associated with an independent prot
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eases preoperatively. Quality of li
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excess risk of 6-18 per 10,000 per
Page 184 and 185:
REFERENCES 1 NHLBI Morbidity and Mo
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36 Samaras K, Hayward CS, Sullivan
Page 188 and 189:
79 Collins P, Rosano GM, Jiang C, L
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121 Mäkelä S, Savolainen H, Aavik
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162 Clarke S, Kelleher H, Lloyd-Jon
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201 Rahimtoola SH, Bennett AJ, Grun
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243 Varas-Lorenzo C, Garcia-Rodriqu
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7. A connection between menopausal
Page 200 and 201:
3. PATHOGENESIS OF FRACTURE Fractur
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Diagnosis of osteoporosis according
Page 204 and 205:
density and has a favorable effect
Page 206 and 207:
How should this information be inco
Page 208 and 209:
emergence of proved treatment alter
Page 210 and 211:
Data on the relation between skelet
Page 212 and 213:
REFERENCES 1 Osteoporosis Preventio
Page 214 and 215:
42 Gluer CC. Quantitative ultrasoun
Page 216 and 217:
85 Ettinger B, Pressman A, Silver P
Page 218 and 219:
130 Jeffcoat MK, Lewis CE, Reddy M,
Page 220 and 221:
1. INTRODUCTION Perimenopausal wome
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for breast cancer are at increased
Page 224 and 225:
findings on biopsy in women with an
Page 226 and 227:
thra. Patients typically describe l
Page 228 and 229:
Biofeedback: Used in conjunction wi
Page 230 and 231:
There has been one systematic revie
Page 232 and 233:
ence in pelvic organ prolapse. The
Page 234 and 235:
21 Ferenczy A. Endometrial carcinom
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65 Wyman JF, Fantl JA, McClish DK,
Page 238 and 239:
222
Page 240 and 241:
1. INTRODUCTION Worldwide, breast c
Page 242 and 243:
difficult to compare because of com
Page 244 and 245:
Although HRT has been related to an
Page 246 and 247:
cyclic use and 2.9 (95 percent CI 2
Page 248 and 249:
TABLE 11-3 Selected Studies on Horm
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TABLE 11-3 (continued) Thus, a stro
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TABLE 11-4 236 Cohort Studies on Ho
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TABLE 11-5 238 Case-Control Studies
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TABLE 11-5 (continued) 240 Adjustme
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When the same women in NSABP were r
Page 260 and 261:
REFERENCES 1 Pisani P, Parkin DM, B
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47 Day NE. Epidemiology: the role o
Page 264 and 265:
93 Rodriguez C, Patel AV, Calle EE,
Page 266 and 267:
139 Parazzini F, La Vecchia C, Negr
Page 268 and 269:
1. INTRODUCTION Menopause is associ
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inverse relation with nonverbal mem
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ease decreased significantly with i
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of households selected to be repres
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standard antipsychotic drugs increa
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5. FUTURE NEEDS • Explore the pos
Page 280 and 281:
19 Berman KF, Schmidt PJ, Rubinow D
Page 282 and 283:
64 Lerner A, Koss E, Debanne S, Row
Page 284 and 285:
114 Smith R, Studd JW. A pilot stud
Page 286 and 287:
162 Klein BE. Lens opacities in wom
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patients with strong personal convi
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Therefore, convincing evidence of t
Page 292 and 293:
3.1.1 Risk Factors Many factors are
Page 294 and 295:
278 lower dosages of estrogen will
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• Diabetes: Women with diabetes b
Page 298 and 299:
Lipids and lipoproteins • LDL cho
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284 persists but is less steep in w
Page 302 and 303:
5.2.3 Pharmacotherapy Breast Cancer
Page 304 and 305:
• There is no clinical trial evid
Page 306 and 307:
Sirtori CR, Pazzucconi F, Colombo L
Page 308 and 309:
Hansson L, Zanchetti A, Carruthers
Page 310 and 311:
Dementia and Mental Health Forette
Page 312 and 313:
CRP C-reactive protein CT computed
Page 314 and 315:
PTCA percutaneous transluminal coro
Page 316:
U.S. DEPARTMENT OF HEALTH AND HUMAN
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