PHYSICAL EXAMINATION

LABORATORY STUDIES

DIAGNOSIS

Female menopause

PATHOPHYSIOLOGY OF KEY SYMPTOMS

Menopause is the time when women’s reproductive cycles end and is part of the natural aging process. Menopause can be induced earlier by surgical removal of the ovaries or occur because of abnormalities of the pituitary or hypothalamus.

After age 35, ovarian mass and fertility begin to decline. Perimenopause describes the gradual depletion of primary follicles. During perimenopause, menstrual cycles decrease by approximately 3 days due to a shortened follicular phase. Hormonal levels will be irregular, but the diminished maturation of follicles will reduce inhibin secretion and lead to a rise in follicle-stimulating hormone (FSH). Ultimately, hormone levels will stabilize in menopause with a high FSH and low estradiol levels but estrone levels remain stable (Figs. 77-1 and 77-2). The fluctuating hormone levels of perimenopause may contribute to the increased incidence of endometrial hyperplasia or carcinoma, uterine polyps, and leiomyoma observed among women of perimenopausal age.

FIGURE 77–1 Total rates of secretion of gonadotropic hormones throughout the sexual lives of female and male humans, showing an especially abrupt increase in gonadotropic hormones at menopause in the female.