Menstrual Cycle

Between menarche (i.e., first menstrual bleeding) and menopause (i.e., last menstrual bleeding), the female reproductive system undergoes cyclic changes called the menstrual cycle.

This includes the maturation and release of oocytes from the ovary during ovulation and periodic vaginal bleeding resulting from the shedding of the endometrial lining.

It is not necessary for a woman to ovulate to menstruate; anovulatory cycles do occur.

The menstrual cycle produces changes in the breasts, uterus, skin, ovaries, and perhaps other, unidentified tissues.

The maintenance of the cycle affects biologic and sociologic aspects of a woman's life, including fertility, reproduction, sexuality, and femaleness.

MENOPAUSE

Menopause is the cessation of menstrual cycles.

Like menarche, it is more of a process than a single event.

Most women stop menstruating between 48 and 55 years of age.

Peri-menopause (the years immediately surrounding menopause) precedes menopause by approximately 4 years and is characterized by menstrual irregularity and other menopausal symptoms.

Climacteric is a more encompassing term that refers to the entire transition to the non reproductive period of life.

Premature ovarian failure describes the approximately 1% of women who experience menopause before the age of 40.

A woman who has not menstruated for a full year or has an FSH level greater than 30 mIU/mL is considered menopausal.

Menopause results from the gradual cessation of ovarian function and the resultant diminished levels of estrogen.

Climacteric is a more encompassing term that refers to the entire transition to the non reproductive period of life.

Premature ovarian failure describes the approximately 1% of women who experience menopause before the age of 40.

A woman who has not menstruated for a full year or has an FSH level greater than 30 mIU/mL is considered menopausal.

Menopause results from the gradual cessation of ovarian function and the resultant diminished levels of estrogen.

Although estrogens derived from the adrenal cortex continue to circulate in a woman's body, they are insufficient to maintain the secondary sexual characteristics in the same manner as ovarian estrogens.

As a result, breast tissue, body hair, skin elasticity, and subcutaneous fat decrease; the ovaries and uterus diminish in size; and the cervix and vagina become pale and friable.

Problems that can arise as a result of this urogenital atrophy include vaginal dryness, urinary stress incontinence, urgency, nocturia, vaginitis, and urinary tract infection. The woman may find intercourse painful and traumatic, although some type of vaginal lubrication may be helpful.

Systemically, a woman may experience significant vasomotor instability secondary to the decrease in estrogens and the relative increase in other hormones.

This instability may give rise to "hot flashes," palpitations, dizziness, and head- aches as the blood vessels dilate.

When they occur at night and are accompanied by significant perspiration, they are referred to as night sweats.

Insomnia as well as frequent awakening because of vasomotor symptoms can lead to sleep deprivation.

A woman may experience irritability, anxiety, and depression as a result of these uncontrollable and unpredictable events.

Consequences of long-term estrogen deprivation include osteoporosis due to an imbalance in bone remodeling (i.e., bone resorption occurs at a faster rate than bone formation), and an increased risk for cardiovascular disease (atherosclerosis is accelerated), which is the leading cause of death for women after menopause.

Hormone replacement therapy (HRT) to slow the rate of bone loss is the gold standard for prevention and treatment of osteoporosis in women.

HRT has been associated with a 50% reduction in coronary heart disease mortality rates.

Secondary prevention in women with established heart disease is less clear.

Estrogen replacement is associated with protection in long-term users but may increase risk of a second cardiovascular event within the first year of HRT use through an increased incidence of deep vein thrombosis and pulmonary emboli.

Research also points to other potential advantages to long-term HRT, including reduced risk of Alzheimer's disease (leading cause of lost independence and institutionalization), decreased risk of colon cancer (third leading cause of cancer death among women), less tooth loss, and lower incidence of macular degeneration (leading cause of legal blindness in the U.S.).

HRT continues to be controversial with women.

An association between the use of estrogen replacement therapy (continuous estrogen only [ERT) and the development of endometrial cancer was noted in the 1970s.

It is now known that unopposed estrogen can lead to the development of endometrial hyperplasia, which in some cases can increase a woman's risk for endometrial cancer.

HRT that involves the use of both estrogen and progesterone is not associated with endometrial cancer. This is being questioned now.

The association with breast cancer is the other area of concern, and the data are not as clear here despite over 5O years of study.

When evaluating the many studies reporting estimated risks of breast cancer associated with ERT / HRT, most of the confidence intervals cross the relative risk of 1 and therefore are not statistically significant.

However, new studies linking estrogen and breast cancer continue to make front-page news, and consequently the worry persists.

If unknown cancer cells exist in the breast, estrogen may accelerate the growth of those cells to a point where the cancer can then be detected.

The risk-benefit ratio must be carefully weighed by women, taking into account their individual circumstances, when making decisions about HRT.

Societal mores influence behaviors.

A society that emphasizes youthfulness, fitness, and vigor may not look on aging as a positive process, and menopause is regarded as a hallmark of advancing age.

A woman who focuses her energy on beauty and youth may feel frustrated or depressed by the natural aging process.

A woman who values her other, nonphysical attributes may welcome advancing age as a time when she may more fully develop as a person. ?

CHANGES WITH MENOPAUSE

At the onset of menopause, the levels of estrogen and progesterone are gradually reduced, and the breasts regress because of loss of glandular tissue.

The lobular-alveolar structures atrophy, leaving fat, connective tissue, and ducts.

The breasts become pendulous with the decrease in tissue mass. ?

Menopause When menopause sets in, a womanĄŻs monthly menstrual cycle draws to a close. Oestrogen production by the ovaries is drastically reduced. Eggs are no longer released for fertilisation and menstruation ceases. The first sign is usually irregularity of periods. Many women also have various other symptoms. The table below indicate some of the most common menopausal symptoms is based on Dutch and British surveys. Most Common Symptoms of Menopause