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At the age of 45 to 55, reproductive system undergoes changes due to the decrease in the secretion of sex hormones estrogen and progesterone. It is called climacteric. In females, climacteric is accompanied by menopause.

Menopause is the period characterized by the permanent cessation of menstruation. Normally it occurs at the age of 45 to 55 years.

In some women, the menstruation stops suddenly. In others, the menstrual flow decreases gradually during every cycle and finally it stops. Sometimes irregular menstruation occurs with lengthening or shortening of the period with less or more flow.

Menopause may occur because of surgical removal of ovaries (ovariectomy) or uterus (hysterectomy) as a part of treatment for abnormal menstruation after the age of 35 years. Usually, females with short menstrual cycle attain menopause earlier than the females with longer cycle. Cigarette smoking causes earlier onset of menopause.


Due to advancement of age the atrophy of ovaries occurs. It leads to the cessation of menstrual cycle causing menopause. Throughout a woman's sexual life, about 450 of the primordial follicles grow into graafian follicles and ovulate, while thousands of the follicles degenerate.

At the age of 45 years, only few primordial follicles still remain to be stimulated by FSH and LH. Now, the production of estrogen by the ovary decreases due to the decrease in the number of primordial follicles. When estrogen secretion becomes almost zero, FSH and LH are continuously secreted. When all the primordial follicles are atrophied, estrogen secretion stops completely.


During menopause, the woman develops certain physical, physiological and psychological changes, which are collectively known as postmenopausal syndrome. The symptoms start appearing soon after the ovaries stop functioning. The main cause for the symptoms is the lack of estrogen and progesterone. The body has to acclimatize to the condition without the stimulatory effects of estrogen and progesterone. The symptoms are mild in some and severe in others. The symptoms last for few months to few years. The symptoms of postmenopausal syndrome are:

  1. Hot flashes characterized by extreme flushing of the skin: Hot flashes start with discomfort in the abdomen and chill which are quickly followed by the feeling of heat spreading towards the head. Then the face becomes red followed by sweating and exhaustion
  2. Vasomotor instability: The blood pressure increases suddenly and it comes back to normal automatically
  3. Fatigue
  4. Nervousness
  5. Emotional outburst like crying and anger
  6. Mental depression
  7. Insomnia
  8. Palpitation
  9. Vertigo
  10. Headache
  11. Numbness or tingling sensation
  12. Urinary disturbances such as increased frequency of micturition
  13. The long-term effects of decreased estrogen levels namely, osteoporosis and atherosclerosis: Osteoporosis is the bone disease resulting in reduction in the mass of the bone. And the bones become easily susceptible for fracture. Atherosclerosis is condition characterized by the deposition of cholesterol on the wall of the blood vessels.

Most of the women manage it very well. But, about 15% of the women need treatment. In many cases, psychotherapy works very well. If it fails, daily administration of estrogen in small quantities will reverse the symptoms. It is called hormone replacement therapy (HRT). The combination of estrogen and progesterone is considered to be more advantageous because progesterone prevents the estrogen induced cancer and hyperplasia of myometrium. The dose of the hormones should be gradually reduced to prevent the reoccurrence of postmenopausal symptoms


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