Postmenopausal

The term "postmenopausal" refers to women who have not experienced any menstrual flow for a minimum of 12 months, assuming that they do still have a uterus, and are not pregnant or lactating. This is considered to mark the transition from fertility to permanent infertility. 

In women without a uterus, menopause or postmenopause can be identified by a blood test showing a very high FSH (follicle-stimulating hormone) level. Thus postmenopause is all of the time in a woman's life that take place after her last period (which is termed menopause, strictly speaking), or more accurately, all of the time that follows the point when her ovaries become inactive. At this point a woman is considered infertile; however, the possibility of becoming pregnant has usually been very low (but not quite zero) for a number of years before this point is reached.

Menopause is usually a natural change. This transition from a potentially reproductive to a non-reproductive state is the result of changes in female hormonal production by the ovaries. Normally not sudden or abrupt, tends to occur over a period of years, and is a consequence of biological aging. For some women, the accompanying signs and effects that can occur during the menopause transition years can significantly disrupt their daily activities and sense of well-being. Specific treatment is not usually needed. Some symptoms, however, may be improved with treatment.

In those who have had surgery to remove the uterus but still have ovaries, menopause may be viewed to have occurred at the time of the surgery or when hormone levels fall. Following the removal of the uterus, symptoms typically occur earlier, at an average of 45 years of age. Other causes include surgery that removes both ovaries, or some types of chemotherapy that render the ovaries inactive. While typically not needed, a diagnosis of menopause can be confirmed by measuring hormone levels in either the blood or urine.

Symptoms

As the body adapts to the changing levels of natural hormones following menopause, vasomotor (affecting the reactivity of blood vessels) symptoms such as hot flashes and palpitations (feelings of abnormal heartbeat), psychological symptoms such as depression, anxiety, irritability, mood swings and lack of concentration, and atrophic symptoms such as vaginal dryness, painful sexual intercourse and urgency of urination appear. 

These menopause symptoms (Pic. 1) are caused by an overall drop, as well as dramatic but erratic fluctuations, in the levels of estrogens (the primary female sex hormones), progesterone (the hormone produced in the second half of the menstrual cycle, and during pregnancy), and testosterone (the primary male sex hormone).

Associated diseases

Endometrial polyps

Endometrial polyps (Pic. 2) are localized, pedunculated or sessile tissue growths consisting of a variable amount of glands, stroma (connective tissue “scaffold”) and blood vessels, localized in the endometrium, the inner mucous lining of the uterine cavity. Endometrial polyps are reported to be most prevalent in the premenopausal and early postmenopausal women, and the prevalence decreases again with older age. Sometimes they ulcerate, bleed or twist, which may lead to partial or complete necrosis (tissue death) and may be the source of abnormal uterine bleeding. Endometrial polyps should also be pointed out as a risk factor for the presence of endometrial adenocarcinoma, which is nine times more frequent in patients with polyps than in patients with no polyps. Although infrequent, polyps can become malignant. To be considered a primary site of malignancy, the tumor must be confined to the apex, with no lesion in its base, as well as in the surrounding endometrium.

Osteoporosis

Osteoporosis (Pic. 3) is a disease that causes a decrease in the amount of bone in the skeleton, and deteriorates the bone structure. In women, the bone tissue loss is greater during the 10 first post-menopausal years, and it can reach 3% a year. Sedentary women lose more bone. Osteoporosis is a common condition. According to the World Health Organization (WHO) criteria, 1/3 of the white women older than 65 present with osteoporosis; it is estimated that osteoporotic fractures will occur in about 50% of the women older than 75 years.

Ovarian cancer

Ovarian cancer is a cancer that begins in an ovary, comprising several different types of tumours. Ovarian cancer remains the leading cause of death from all gynaecological tumours due to the lack of both symptoms at an early stage and a reliable clinical test. The dismal fact is that 75% of patients are diagnosed when the tumour has spread or metastasized into the peritoneal wall or abdominal cavity. Ovarian cancer typically occurs in older, postmenopausal women. The risk of ovarian cancer increases in women who have ovulated more over their lifetime. This includes those who have never had children, those who begin ovulation at a younger age or reach menopause at an older age.

Complications

Cardiovascular disease

Cardiovascular disease (CVD) is an umbrella term for any disease affecting the heart and the blood vessels, including coronary artery disease (such as myocardial infarction), heart failure, heart arrhythmias, cerebrovascular accidents (strokes), peripheral artery disease, thromboembolism and many others. The underlying process of most of these is the process of atherosclerosis, narrowing of the arteries due to growth of plaques in their walls. An important class of hormones affecting the process of atherosclerosis are estrogens, the primary female sex hormones. Therefore, women before their menopause are 2 to 5 times less likely to have cardiovascular disease than men of the same age. Following menopause, the risk of cardiovascular disease gradually evens up, and later even exceeds the risk rate for males. 

Risk factors

Menopause is a natural phase of a woman’s life. However, the decline in the ovarian activity and subsequent menopause may start at an earlier age in certain women. Known risk factors for an earlier menopause include:

• family history of earlier menopause
• smoking
  
• cancer treatment – chemotherapy, or radiotherapy in the pelvic region
• hysterectomy (surgical removal of the uterus)

Prevention

Menopause is caused by the cessation of ovarian cycle, the key component of menstrual cycle, and permanent failure of the ovaries to release oocytes. Together with its associated hormonal changes, this marks the transition from the fertile phase of a woman’s life (although, for several years before the menopause, the woman’s fertility is already significantly reduced) to the phase of natural infertility.

Women will often, but not always, start this transition (menopause) about the same time as their mother did. After one year of amenorrhea (absent menstrual cycles), indicating the phase of postmenopause, women experience a well-defined profile of hormones, with low estrogen and progesterone, and high gonadotropin levels. These hormonal changes cause, in a significant portion of women, menopause-related symptoms, that may well precede the definite cessation of menstrual cycle and without treatment may last for a couple of years following menopause.