menopause

Menopause is the permanent end of menstruation and fertility, diagnosed after 12 consecutive months without a menstrual period. It results from declining ovarian function and falling levels of estrogen and progesterone. The transition to menopause, called perimenopause, can begin several years before the final period. Most people reach menopause in the late 40s to early 50s, with a median age around 51.

Symptoms during the transition and after include vasomotor symptoms—hot flashes and night sweats—sleep disturbance, and vaginal dryness with thinning of the vaginal tissues. Other possible changes include reduced sexual desire, mood fluctuations, cognitive changes, and urinary symptoms. The type, severity, and duration vary widely between individuals.

Lower estrogen levels contribute to bone loss and an increased risk of osteoporosis and fractures. Cardiovascular risk may rise after menopause, and some people experience long-term urogenital changes. Many symptoms improve over time, but others persist for years or become chronic.

Natural aging is the most common cause. Surgical menopause from oophorectomy, or treatments such as chemotherapy or pelvic radiation, can cause earlier or sudden menopause. Risk factors for earlier menopause or more severe symptoms include smoking and certain medical conditions. Family history can influence timing but does not determine symptoms.

Diagnosis is usually clinical, based on menstrual history and symptoms; laboratory tests are not routinely required. Management focuses on symptom relief and health maintenance. Options include lifestyle measures (cool environments, regular exercise, sleep hygiene), nonhormonal medications for vasomotor symptoms, and local estrogen therapy for vaginal symptoms. Hormone therapy can relieve many vasomotor and urogenital symptoms in appropriate candidates but carries risks that must be weighed individually. Adequate calcium and vitamin D, weight-bearing exercise, and routine cardiovascular risk assessment support overall health.