WOMEN 'S HEALTH AND MENOPAUSE : - National Heart, Lung ...

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