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Menopause is the permanent cessation of menstrual
cycles following the loss of ovarian follicular activity
(FIG.1). This may be spontaneous (natural menopause)
or iatrogenic (secondary menopause). The latter includes
removal of both ovaries (surgical menopause), as well as
ovarian failure resulting from chemotherapy or radio-
therapy. To facilitate research on menopause, investiga-
tors convened in 2001 and reported the first Staging of
Reproductive Aging Workshop (STRAW) recommenda-
tions
1
. Staging is not only useful for research; it can also
facilitate dialogue between a woman and her clinician,
and between clinicians. A refined STRAW classification
was published in 2012 and includes several data-driven
adjustments to the original publication
2–5
.
Briefly, the STRAW classification (summarized in
FIG.2) separates a woman’s life into seven segments,
with segments –2, –1 and 0 including the early meno-
pausal transition, the late menopausal transition and
the final menstrual period, respectively. Age at natural
menopause is used to indicate the timing of menopause
and is confirmed after 1year of amenorrhoea. The early
transition is defined as a departure from previously
regular menstrual cycle lengths of ≥7days, or a skipped
menstrual period. During this stage, oestrogen levels
are fluctuating but are sufficient overall, and cycles
are usually ovulatory. If oestrogen levels drop, they are
not maintained at a very low level for long, but will
fluctuate until after menopause. Thus, symptoms are
generally mild at this stage of the transition and most
women will notice them but not require treatment.
Clearly, the STRAW staging primarily applies to
women experiencing spontaneous menopause and not
those with secondary menopause. It is also less useful
for women who are unable to observe a change in their
menstrual bleeding patterns, owing to hysterectomy,
endometrial ablation, hormonal contraception with
suppressed ovarian cycles or a progestin intrauterine
device, for example. For such women, the occurrence of
menopausal symptoms, due to the fall in ovarian oestro-
gen production, may provide the first indication of the
menopause
6
. Although not all women experience sig-
nificant symptoms, the fall in oestrogen at menopause
results in changes throughout the body including bone
loss, a tendency to increased abdominal fat and a more
adverse cardiovascular risk profile. In this Primer article,
we summarize the current understanding of the physiol-
ogy and clinical consequences of menopause, as well as
the available treatment options.
Epidemiology
The first reliable epidemiological estimates for the tim-
ing of menopause give a median age at natural meno-
pause of 48–52years among women in developed
nations
7
. In a more recent and broader meta-analysis
8
of
36 studies spanning 35 countries, the overall mean age
was 48.8years (95% CI 48.3–49.2), with considerable
Correspondence to S.R.D.
e‑mail: susan.davis@
monash.edu
School of Public Health and
Preventive Medicine,
MonashUniversity,
99Commercial Road,
Melbourne, Victoria 3004,
Australia.
Article number: 15004
doi:10.1038/nrdp.2015.4
Published online
23 April 2015
Menopause
Susan R.Davis
1
, Irene Lambrinoudaki
2
, Maryann Lumsden
3
, Gita D.Mishra
4
,
LubnaPal
5
, Margaret Rees
6
, Nanette Santoro
7
and Tommaso Simoncini
8
Abstract | Menopause is an inevitable component of ageing and encompasses the
loss of ovarian
reproductive function, either occurring spontaneously or secondary to other
conditions. It is not yet
possible to accurately predict the onset of menopause, especially early
menopause, to give women
improved control of their fertility. The decline in ovarian oestrogen production
at menopause can cause
physical symptoms that may be debilitating, including hot flushes and night
sweats, urogenital atrophy,
sexual dysfunction, mood changes, bone loss, and metabolic changes that
predispose to cardiovascular
disease and diabetes. The individual experience of the menopause transition
varies widely. Important
influential factors include the age at which menopause occurs, personal health
and wellbeing, and each
woman’s environment and culture. Management options range from lifestyle
assessment and intervention
through to hormonal and non-hormonal pharmacotherapy, each of which has specific
benefits and risks.
Decisions about therapy for perimenopausal and postmenopausal women depend on
symptomatology,
health status, immediate and long-term health risks, personal life expectations,
and the availability and
cost of therapies. More effective and safe therapies for the management of
menopausal symptoms need
to be developed, particularly for women who have absolute contraindications to
hormone therapy.
Foranillustrated summary of this Primer, visit:
http://go.nature.com/BjvJVX
PRIMER
NATURE REVIEWS
|
DISEASE PRIMERS VOLUME 1
|
2015
|
1
© 2015 Macmillan Publishers Limited. All rights reserved























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