Menopause is defined as the absence of menstrual periods for at least 12 months. It typically occurs between ages 45-55, though can happen as early as age 30. Menopause is caused by a loss of responsiveness of the ovaries to hormones like FSH and LH, causing lower estrogen and progesterone levels. Common symptoms include irregular periods, hot flashes, mood changes, and increased risk for osteoporosis and heart disease. Treatment options include hormone replacement therapy, antidepressants, lifestyle changes, and lubricants to relieve vaginal dryness.

1. Menopause Alicia Carl Jamie Mathias

2. What is Menopause? The state of an absence of menstrual periods for at least 12 months. Starts with varying menstrual cycle lengths and ends with the final menstrual period.

3. When do women reach Menopause? Average age: 51 years old. HOWEVER, there is no way to predict when exactly an individual woman will enter menopause. Most women reach menopause between the ages of 45 and 55. May occur as early as age 30.

4. Menstruation Pituitary gland in the brain secretes FSH and LH, initiating menstruation. These hormones act on the ovaries to begin the process of releasing an egg from the ovary each month. Under the action of these hormones, the ovary will produce estrogen and progesterone. These four hormones all work together to cause the growth and release of one egg each month. If pregnancy does not occur to put a stop to this process, each cycle ends with a menstrual flow.

5. Review Anterior Pituitary FSH & LH Ovaries Estrogen & Progesterone Ovulation Menstruation http://en.wikipedia.org/wiki/File:Follicle-stimulating_hormone_%28FSH%29_during_menstrual_cycle.png

6. What causes menopause to occur? Loss of responsiveness to LH and FSH; causing ovaries to produce less estrogen and progesterone by age 40. Production FSH and LH increase significantly in an attempt to stimulate ovaries. Changes in the cycle begin to take place anywhere from 2 to 10 years before actual menopause. Ovaries produce less estrogen and progesterone; therefore, menstruation stops completely.

7. Symptoms Irregular vaginal bleeding Hot flashes & night sweats Vaginal dryness, itching, irritation and/or pain with sexual intercourse Urinary tract infection and/or urinary incontinence Fatigue, memory problems, irritability, and rapid changes in mood. Weight gain Acne Hair growth on face or abdomen

8. Health Concerns Osteoporosis Deterioration of bone and bone density. Results in an increased risk of fracture. Density begins to decline by age 40. Accelerated during menopause. Both age and the hormonal changes due to the menopause transition act together to cause osteoporosis.

9. Health Concerns Cardiovascular disease Prior to menopause, women have a decreased risk of heart disease and stroke when compared with men. Around the time of menopause, however, a women's risk of cardiovascular disease increases.

10. Reducing Symptoms and Health Risks Hormone Replacement Therapy (with Estrogen) Benefits: Relief of hot flashes Prevention of osteoporosis Risks: Endometrial cancer if not taken with progesterone Blood clots Breast cancer Gallbladder disease Possible risks: Cardiovascular disease Ovarian cancer Alzheimer’s disease Colon cancer No risk or benefit

11. Reducing Symptoms and Health Risks Venlafaxine (Effexor) Shown to relieve hot flashes. Can also be used to treat depression. Paroxetine (Paxil) Antidepressant that has been shown to work for hot flashes. Clonidine Medication used to treat high blood pressure and may help women with hot flashes.

12. Non-Hormonal Therapy Over-the-counter vaginal lubricants. Not as effective in relieving vaginal symptoms as replacing the estrogen deficiency with oral or local estrogen.

13. Non-Hormonal Therapy Lead a healthy lifestyle. Regular exercise Help protect against cardiovascular disease as well as osteoporosis, and exercise also has known mental health benefits. Proper nutrition Quit smoking! Lowers risk of cardiovascular disease

14. Key points Menopause isn't an illness. It's a natural part of your life. It happens when your body stops making certain hormones. The symptoms of menopause can be distressing, but you don't have to put up with them. You can get help.

15. Key Points The main treatment for menopause is hormone replacement therapy (HRT). But if you don't want to take this, there are other treatments that might also help. There are things you can do yourself to help relieve symptoms of menopause.

16. References Newton KM; Reed SD; LaCroix AZ et al. Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo: a randomized trial. Ann Intern Med. 2006 Dec 19;145(12):869-79. Rossouw JE; Anderson GL; Prentice RL et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA 2002 Jul 17;288(3):321-33. Utian WH; Archer DF; Bachmann GA, et al. Estrogen and progestogen use in postmenopausal women: July 2008 position statement of The North American Menopause Society. Menopause. 2008 Jul-Aug;15(4 Pt 1):584-602. Weber, Valerie. Menopause FAQs.Hamilton, ON, CAN: B.C. Decker Incorporated, 2007. p 1.http://site.ebrary.com/lib/csufresno/Doc?id=10171435&ppg=9Copyright © 2007. B.C. Decker Incorporated. All rights reserved. The North American Menopause Society.Menopause Core Curriculum Study Guide.The North American Menopause Society; Cleveland, Ohio, U.S.; 2000. Menstration Graph. http://en.wikipedia.org/wiki/File:Follicle-stimulating_hormone_%28FSH%29_during_menstrual_cycle.png