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menopause

menopause (mĕn´əpôz) or climacteric (klīmăk´tərĬk, klī´măktĕr´Ĭk), 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).

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