The Menopause and Beyond

  • Fran E. Kaiser
  • John E. Morley

Abstract

Menopause is the permanent cessation of menses. In the United States, the mean age at menopause is approximately 51 years, with the majority of women experiencing menopause at 45 to 55 years of age. The age at which menopause occurs has not altered substantially since the first available records, which placed it at 50 years in medieval Europe. The major change has been that, with increasing longevity, women now live approximately a third of their total life span after menopause. Menstruation beyond age 55 years increases the possibility of endometrial hyperplasia and/or malignancy and requires that an endometrial biopsy be performed. The age at menopause is not altered by use of oral contraceptives, age at or number of pregnancies, age at menarche, race, body habitus, or socioeconomic conditions. The major environmental factor altering the age at onset of menopause is cigarette smoking, which causes, menopause to occur 1 to 2 years earlier than might be predicted. The hormonal basis of menopause is decreased ovarian steroidogenesis, which occurs in the face of adequate gonadotropin stimulation.

Keywords

Postmenopausal Woman Endometrial Cancer Granulosa Cell Estrogen Replacement Therapy Vasomotor Symptom 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Borner E. The menopause. In: Cyclopaedia of Obstetrics and Gynecology. New York, NY: William Wood; 1887.Google Scholar
  2. 2.
    Budoff PW. No More Hot Flashes and Other Good News. New York; NY: GP Putnam’s Sons; 1983.Google Scholar
  3. 3.
    Cutler WB, Garcia CR, Edwards DA. Menopause: A guide for Women and the Men Who Love Them. New York; NY: Norton; 1983.Google Scholar
  4. 4.
    Haney AF. The ‘physiology’ of the climacterium. Clin Obstet Gynecol 1986; 29: 397–405.PubMedCrossRefGoogle Scholar
  5. 5.
    Jick H, Porter J, Morrison AS. Relation between smoking and age of natural menopause: report from Boston Collaborative Drug Surveillance Program, Boston University Medical Center. Lancet 1977; 1: 1354–1356.PubMedCrossRefGoogle Scholar
  6. 6.
    Judd HL, Davidson BJ, Frumar AM, et al. Serum androgens and estrogens in postmenopausal women with and without endometrial cancer. Am J Obstet 1980; 136: 859–871.Google Scholar
  7. 7.
    Sherman BM, West JH, Korenman SG. The menopausal transition: analysis of LH, FSH, estradiol and progesterone concentrations during menstrual cycles of older women. J Clin Endocrinol Metab 1976; 42: 629–636.PubMedCrossRefGoogle Scholar
  8. 8.
    Kohler PO, Ross GT, Odell WD. Metabolic clearance and production rates of human luteinizing hormone in pre-and post-menopausal women. J Clin Invest 1968; 43: 381–388.Google Scholar
  9. 9.
    Scaglia H, Medina M, Pinto-Ferreira Al, et al. Pituitary LH and FSH section and responsiveness in women of old age. Acta Endocrinol 1976; 81: 673–679.PubMedGoogle Scholar
  10. 10.
    Petraglia A, Porro C, Facchinetti F, et al. Opioid control of LH secretion in humans: menstrual cycle, menopause and aging reduce effect of naloxone but not of morphine. Life Sci 1986; 38: 2103–2110.PubMedCrossRefGoogle Scholar
  11. 11.
    Melis GB, Cagnacci A, Gambacciani M, et al. Chronic bromocriptine administration restores luteinizing hormone response to naloxone in post-menopausal women. Neuroendocrinology 1988; 47: 159–163.PubMedCrossRefGoogle Scholar
  12. 12.
    Mishell DR, Jr, Brenner PF. Menopause. In: Mishell DR, Jr, Davajan V, eds. Infertility, Contraception, and Reproductive Endocrinology. 2nd ed. Oradell, NJ: Medical Economics Books; 1986: 179–202.Google Scholar
  13. 13.
    Erik Y, Meldrum DR, Judd HL. Estrogen levels in post-menopausal women with hot flashes. Obstet Gynecol 1982; 59: 403–411.Google Scholar
  14. 14.
    Kronenberg M, Carraway RE. Changes in neurotensinlike immunoreactivity during menopausal hot flashes. J Clin Endocrinol Metab 1985; 60: 1081–1086.PubMedCrossRefGoogle Scholar
  15. 15.
    Jaffe RB. The menopausal and perimenopausal period. In: Yen SSC, Jaffe RB, eds. Reproductive Endocrinology. Philadelphia, Pa: WB Saunders Co; 1986.Google Scholar
  16. 16.
    Tataryn IV, Meldrum DR, Lu LH, et al. LH, FSH, and skin temperature during the menopausal hot flash. J Clin Endocrinol Metab 1979; 49: 152–158.PubMedCrossRefGoogle Scholar
  17. 17.
    Svenson TH. Clonidine treatment in vegetative dysfunction: experimental reationales. Acta Obstet Gynecol Scand Suppl 1985; 132: 23–28.CrossRefGoogle Scholar
  18. 18.
    Hammar M, Berg G. Clonidine in the treatment of menopausal flushing. Acta Obstet Gynecol Scand Suppl 1985; 132: 29–31.PubMedCrossRefGoogle Scholar
  19. 19.
    Cox B, Lee TF. Further evidence for a physiological role for hypothalamic dopamine in thermoregulation in the rat. J Physiol 1980; 300: 7–12.PubMedGoogle Scholar
  20. 20.
    David A, Don R, Tajchner G, et al. Veralipride: alternative antidopaminergic treatmtne for menopausal symptoms. Am J Obstet Gynecol 1988; 158: 1107–1115.PubMedGoogle Scholar
  21. 21.
    Paterson MEL. Randomized double-blind crossover trial into the effect of norethisterone on climateric symptoms and biochemical profile. Br J Obstet Gynecol 1982; 89: 464–472.CrossRefGoogle Scholar
  22. 22.
    Laufer LR, Erlik Y, Meldrum DR, et al. Effect of chlonidine on hot flashes in postmenopausal women. Obstet Gynecol 1982; 60: 583–586.PubMedGoogle Scholar
  23. 23.
    Lightman SL, Jacobs HS. Naloxone suppresses menopausal hot flushes. Lancet 1979; 2: 1071–1074.PubMedCrossRefGoogle Scholar
  24. 24.
    Campbell S. Double-blind psychometric studies on the effects of natural estrogens on post-menopausal women. In: Campbell S, ed. Management of the Menopause and Post-Menopausal Years. Lancaster, England: MTP Press Ltd; 1976: 152–163.CrossRefGoogle Scholar
  25. 25.
    Strathy JH, Coulam CB, Spelsburg TC. Comparison of estrogen receptors in human premenopausal and postmenopausal uteri: indication of biologically inactive receptor in postmenopausal uteri. Am J Obstet Gynecol 1982; 142: 372–376.PubMedGoogle Scholar
  26. 26.
    Greenwood S. Hysterectomy and ovarian removal: a major health issue in the perimenopausal years. West J Med 1988; 149: 771–772.PubMedGoogle Scholar
  27. 27.
    Kikku P, Gronroos M, Hirvonen T, et al. Supravaginal uterine amputation vs. hysterectomy: effects on libido and orgasm. Acta Obstet Gynecol Scand 1983; 62: 147–152.CrossRefGoogle Scholar
  28. 28.
    Shearer MR, Shearer ML. Sexuality and sexual counseling in the elderly. Clin Obstet Gynecol 1977; 20: 197–208.PubMedCrossRefGoogle Scholar
  29. 29.
    Masters W, Johnson V. Human sexual response. Boston; Mass: Little Brown & Co Inc, 1970.Google Scholar
  30. 30.
    Garde K, Lunde I. Female sexual behavior in a random sample of 40-year-old women. Maturitas 1980; 2: 225–240.PubMedCrossRefGoogle Scholar
  31. 31.
    Osborn M, Hawton K, Gath D. Sexual dysfunction among middle-aged women in the communuity. Bri Med J 1988; 296: 959–962.CrossRefGoogle Scholar
  32. 32.
    McCoy NL, Davidson JM. A longitudinal study of the effects of menopause on sexuality. Maturitas 1985; 7: 203–210.PubMedCrossRefGoogle Scholar
  33. 33.
    Starr BD, Weiner MB. On Sex and Sexuality in the Mature Years. New York; NY: Stein & Day Publishers, 1981.Google Scholar
  34. 34.
    Kinsey AC, Pomeroy WB, Martin CE. Sexual Behavior in the Human Female. Philadelphia, Pa: WB Saunders; 1953.Google Scholar
  35. 35.
    Newman G, Nichols CR. Sexual activities and attitudes in older persons. JAMA 1960; 173: 33–35.CrossRefGoogle Scholar
  36. 36.
    Bretschneider JG, McCoy NL. Sexual interest and behavior in helathy 80- to 102-year-olds. Arch Sex Behav 1988; 17: 109–129.PubMedCrossRefGoogle Scholar
  37. 37.
    Persson G. Sexuality in a 70-year-old urban population. J Psychosom Res 1980; 24: 137–154.CrossRefGoogle Scholar
  38. 38.
    Salmon TJ, Geist SH. Effect of androgens on libido in women. J Clin Endocrinol Metab 1943; 3: 235–238.CrossRefGoogle Scholar
  39. 39.
    Studd JWW, Collins WP, Charkrvati S. Oestradiol and testosterone implants in the treatment of psychosexual problems in the postmenopausal women. Br J Obstet Gynaecol 1977; 84: 314–316.Google Scholar
  40. 40.
    Adelman M. Long Time Passing: Lives of Older Lesbians. Boston; Mass: Alyson Publications Inc; 1986.Google Scholar
  41. 41.
    Davis LJ. Rape and older women. In: Warner CG, ed. Rape and Sexual Assault Management and Intervention. Rockville, Md: Aspen Publishers; 1980: 94–118.Google Scholar
  42. 42.
    Ross RK, Paganini-Hill A, Mack TM. Menopausal oestrogen therapy and protection from death from ischemic disease. Lancet 1981; 1: 858–862.PubMedCrossRefGoogle Scholar
  43. 43.
    Bush TL, Barrett-Connor E, Cowan LD, et al. Cardiovascular mortality and non-contraceptive use of estrogen in women: results from the Lipid Research Clinics Program Follow-up Study. Circulation 1987; 75: 1102–1109.CrossRefGoogle Scholar
  44. 44.
    Colditz GA, Willett WC, Stampfer MJ, et al. Menopause and the risk of coronary heart disease in women. N Engl J Med 1987; 316: 1105–1110.PubMedCrossRefGoogle Scholar
  45. 45.
    Ottosson UB, Carlstrom K, Johansson BG, et al. Estrogen induction of liver proteins and high-density liporpotein cholesterol: comparison between estradiol vale-nate and ethinyl estradiol. Gynecol Obstet Invest 1986; 22: 198–205.PubMedCrossRefGoogle Scholar
  46. 46.
    Farish E, Fletcher CD, Hart DM et al. The effects of conjugated equine oestrogens with and without a cyclical progestogen on lipoproteins and HDL subfractions in postmenopausal women. Acta Endocrinol 1986; 113: 123–127.PubMedGoogle Scholar
  47. 47.
    Collins J, Donner A, Allen LH, et al. Oestrogen use and survival in endometrial cancer. Lancet 1980; 2: 961–963.PubMedCrossRefGoogle Scholar
  48. 48.
    Varma TR. Effect of long-term therapy with estrogen and progesterone on endometrium of postmenopausal women. Acta Obstet Gynecol Scand 1985; 64: 41–46.PubMedCrossRefGoogle Scholar
  49. 49.
    Wingo PA, Layde PM, Lee NC, et al. The risk of breast cancer in postmenopausal women who have used estrogen replacement therapy. JAMA 1987; 257: 209–215.PubMedCrossRefGoogle Scholar
  50. 50.
    Boston Collaborative Drug Project: Surgically confirmed gallbladder disease, venous thromboembolism, and breast tumors in relation to postmenopausal estrogen therapy. N Engl J Med 1974; 290: 15–19.CrossRefGoogle Scholar
  51. 51.
    Barrett-Connor E. Postmenopausal estrogens: current prescribing patterns of San Diego gynecologists. West J Med 1986; 144: 620–621.PubMedGoogle Scholar
  52. 52.
    Hammond CB, Jelovsek FR, Lee KL, et al. Effects of long-term estrogen replacement therapy, I: metabolic. Am J Obstet Gynecol 1979; 133: 525–536.PubMedGoogle Scholar
  53. 53.
    Nachtigall L, Nachtigall RH, Nachtigall RD, et al. Estrogen replacement, II: a prospective study in the relationship t carcinoma and cardiovascular and metabolic problems. Obstet Gynecol 1979; 54: 74–79.PubMedCrossRefGoogle Scholar
  54. 54.
    Gambrell RD Jr, Castaneda TA, Ricci CA. Management of postmenopausal bleeding to prevent endometrial cancer. Maturitas 1978; 1: 99–106.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1990

Authors and Affiliations

  • Fran E. Kaiser
  • John E. Morley

There are no affiliations available

Personalised recommendations