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3 consecutive months of amenorrhea or cycle lengths 42 days may indicate impending menopause

Who is most affected

  • Perimenopause most common in women aged 40-58 years
  • Mean age of onset of natural menopause is 51 years in North America

Likely risk factors

  • Increasing age
  • Risk factors for early menopause (menopause in women aged < 40 years):
    • Smoking
    • Radiation or chemotherapy
    • Hysterectomy
    • Low socioeconomic status

Risk factors for vasomotor symptoms

  • Lack of exercise
  • Maternal history of vasomotor symptoms
  • Menopause at < 52 years old
  • Induced menopause
  • Current smoking associated with increased risk of moderate-to-severe hot flashes


  • Menopause results from oocyte depletion and ovarian failure, leading to reduced secretion of ovarian hormones estrogen and progesterone
  • May occur naturally due to increasing age, or be induced by surgery, chemotherapy, or radiation


  • Menopause may be asymptomatic
  • Symptoms associated with menopausal transition may vary in duration and severity, and include:

Vasomotor symptoms

Hot flashes, characterized by sudden sensation of heat in the upper body, perspiration, flushing, chills, clamminess, anxiety, heart palpitations, night sweats, sleep disturbances

Urogenital symptoms

  • Vaginal atrophy, characterized by vaginal dryness, discharge, itching, dyspareunia and sexual dysfunction

History of present illness

  • Length of menstrual cycle progressively increases closer to menopause.
  • 3 consecutive months of amenorrhea or cycle lengths > 42 days may indicate impending menopause
  • Hot flashes characterized by sudden sensation of extreme heat in the upper body, particularly the face, chest and neck, typical duration 1-5 minutes

Treatment overview

Lifestyle modifications, including diet and exercise, may help reduce menopausal symptoms

For treatment of vasomotor symptoms

  • Hormonal therapies systemic hormone therapy with estrogen alone or in combination
  • Nonhormonal therapies for alleviation of vasomotor symptoms

For treatment of urogenital symptoms

  • Hormone therapy is recommended during perimenopause and early menopause for treatment of vulvovaginal atrophy


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