Menopause: Everything You Need to Know About Biology, Consequences, Supportive Care, and Treatment

In this comprehensive guide, we delve into the intricacies of menopause, a natural biological event that women experience as they age. Menopause marks the end of ovarian function, resulting in the loss of reproductive hormone production and fertility. This transformative phase varies in its effects, duration, and perception among individuals and across different cultures. Our aim here is to provide you with a wealth of information about the biology, diagnostic approaches, terminology, and timing of menopause, empowering you with valuable insights into this critical stage of a woman's life.

Terminology: Defining Menopause

Women who undergo surgical removal of both ovaries before their natural menopause are said to have experienced surgical menopause. It's important to note that a hysterectomy alone does not constitute surgical menopause. Additionally, the term "early menopause" is defined as menopause occurring between the ages of 40 and 45 in Western countries, while complete loss of ovarian function before the age of 40 is termed premature ovarian insufficiency (POI). However, these definitions may not be universally applicable across all regions.

Biology of Menopause and Diagnostic Approaches

Menopause, conventionally defined as a year without a menstrual period due to oocyte depletion, doesn't apply to women with irregular periods or amenorrhea for various reasons before their menopausal transition. Understanding the stages of reproductive aging is critical, as they help pinpoint menopause more accurately.

The Stages of Reproductive Aging Workshop +10 (STRAW+10) provides a classification system that profiles menopause from regular menstrual cycles to postmenopausal amenorrhea. The onset of the menopause transition is typically marked by a missed menstrual period. This transition varies in duration and can last for several years.

As women progress through the transition, hormonal changes become more pronounced, leading to the emergence of classic menopausal symptoms, including hot flashes, night sweats, vaginal dryness, sleep disturbances, and mood swings. The late transition typically lasts around four years and is characterized by erratic hormone production.

Timing of Menopause

The timing of menopause is relatively consistent across geographical regions and ethnic groups, occurring at approximately 49 years of age. This consistency is influenced by complex genetic traits that remain largely unidentified. Ovarian function progressively decreases throughout a woman's life, starting in utero, and is characterized by a continuous loss of oocytes. This process is a primary determinant of the onset of menopause.

The rate of oocyte loss is influenced by factors such as apoptosis, and it occurs independently of reproductive events or hormones. Additionally, as women approach menopause, their ovarian follicular cells become less sensitive to pituitary gonadotrophins (FSH and LH), leading to altered ovulation and menstrual irregularities.

There is also evidence of changes in the hypothalamus during the early stages of the menopausal transition, impacting the release of GnRH and, consequently, affecting reproductive aging. These modifications, including the alteration of LH release, contribute to disrupted ovulation and decreased fertility.

As women progress through the transition, hormonal changes become more pronounced, leading to the emergence of classic menopausal symptoms, including hot flashes, night sweats, vaginal dryness, sleep disturbances, and mood swings. The late transition typically lasts around four years and is characterized by erratic hormone production.

Symptoms of Menopause and Their Management

Menopausal symptoms can vary greatly from one individual to another. Some women may find the transition to be a minor inconvenience, while others may be significantly impacted by disabling symptoms. These symptoms include hot flashes, night sweats, vaginal dryness, sleep disturbances, mood swings, and more.

One of the most effective treatments for bothersome menopausal symptoms is menopausal hormone therapy (MHT). MHT not only alleviates these symptoms but also reduces bone loss and may have cardiometabolic benefits. Evidence-based non-hormonal interventions are also available for those who prefer alternatives to MHT.

It's important to note that most MHT regimens are not regulator approved for perimenopausal women, highlighting the need for further research to determine the efficacy and safety of treatment options in this specific group.

Menopausal Symptoms: A Complex Landscape

Menopausal symptoms can vary significantly from woman to woman. The most common symptoms include:

1. Vasomotor Symptoms (VMS)

VMS, which encompass hot flashes and night sweats, are perhaps the most recognizable menopausal symptoms. These sudden, intense waves of heat can disrupt daily activities and sleep. Surprisingly, VMS can begin even before the official menopause transition, affecting many women well before their 50s.

2. Sleep Disruption

Sleep disturbances, including difficulty falling asleep, maintaining sleep, and early morning awakenings, become increasingly common as women progress through menopause. Factors such as hormonal changes, mood disorders, stress, and obesity can contribute to sleep issues.

3. Anxiety and Low Mood

Mood changes are a recognized part of menopause, with anxiety and depressive symptoms often reported. It's important to note that while these symptoms may coincide with menopause, preexisting anxiety and depression can also play a role. Women who enter menopause with high anxiety may actually experience a reduction in anxiety as they progress through this phase.

4. Urogenital Changes

The urogenital changes associated with menopause are often underreported. These changes are primarily due to hypoestrogenism, leading to thinning of the vaginal epithelium, decreased superficial cells, and reduced glycogen production. This can result in dryness, irritation, and discharge, and significantly impact sexual function.

Diversity in Menopausal Experiences

Menopause doesn't affect all women in the same way, and regional and socioeconomic factors can play a significant role. In some countries, moderate to severe joint pain is more common than troublesome VMS. Overweight and obesity, smoking, and lower socioeconomic status are associated with a greater likelihood of experiencing VMS.

Duration of Symptoms

The duration of menopausal symptoms varies widely. Some women experience them for only a few years, while others may endure them for over a decade. Factors like the timing of symptom onset and their severity can influence how long they last. Notably, women with later-onset and severe VMS are more likely to have a longer symptom duration.

The Silent Health Consequences

Beyond the immediate symptoms, menopause can have silent health consequences that impact women's overall well-being. These include:

Cardiovascular Effects

The hormonal changes during menopause are associated with an increased risk of cardiovascular disease. It's crucial for women to maintain regular health screenings, manage risk factors like obesity and hypertension, and adopt a healthy lifestyle to reduce this risk.

Bone Health

Menopause is also linked to changes in bone density and an increased risk of osteoporosis. Routine bone density screenings and proper nutrition are key for safeguarding bone health during and after menopause.

Metabolic Changes

Metabolism undergoes alterations during menopause, leading to changes in body composition and an increased risk of diabetes. The redistribution of fat towards the abdominal area, insulin resistance, and unfavorable lipid profiles are common. Estrogen plays a crucial role in insulin sensitivity, and its loss can contribute to these metabolic changes.

Cancer Risks

The hormonal shifts during menopause are associated with an increased risk of certain cancers, particularly those related to central adiposity. Regular screenings for breast, cervical, and colon cancers are essential for early detection and treatment.

Lifestyle Optimization

To navigate the challenges of menopause and mitigate its health effects, lifestyle optimization is crucial. This includes:

Nutrition

A balanced diet is essential for maintaining overall health. Proper nutrition can help manage weight, reduce the risk of diabetes, and support bone health.

Physical Activity

Staying active is vital for preventing muscle atrophy, maintaining insulin sensitivity, and supporting cardiovascular health. Strength and resistance training can be particularly beneficial.

Sleep

Quality sleep is essential for overall well-being. Strategies to improve sleep can help alleviate menopausal symptoms and maintain cognitive and psychological health.

Stress Reduction

Stress management techniques, such as meditation and mindfulness, can help women cope with the emotional changes associated with menopause.

Alcohol and Smoking

Reducing alcohol consumption and quitting smoking can have a positive impact on health during and after menopause.

The Bone-Muscle Unit

The connection between bone and muscle health is a profound one. The shared embryogenesis of bone and skeletal muscle establishes a strong foundation for understanding the intricate interplay between these two essential components of our musculoskeletal system. Throughout a woman's life, the importance of maintaining muscle mass and bone mineral content becomes increasingly evident.

Muscle-Bone Interaction: Muscle proteins play a vital role in modulating bone turnover, while bone proteins exert anabolic effects on muscle. Furthermore, the mechanical load exerted by muscles on bones influences bone remodeling. This interdependence ensures the stability and strength of our musculoskeletal framework.

Menopause and Bone Health

The onset of menopause triggers a decline in estrogen levels, which, in turn, accelerates bone resorption, surpassing bone formation. The key player in this process is Receptor Activator of Nuclear Factor Kappa Ligand (RANKL), produced by osteoblastic cells and immune cells within the bone. RANKL stimulates the differentiation and activity of bone-resorbing cells, known as osteoclasts, leading to increased bone resorption.

With insufficient estrogen during menopause, there is inadequate suppression of RANKL, resulting in a surge of osteoclast numbers, activation, and longevity. This heightened bone resorption ultimately contributes to conditions like osteopenia and osteoporosis, increasing a woman's risk of fractures. Additionally, estrogen has a protective effect against bone-resorbing cytokines, interleukin-1, and tumor necrosis factor-α, further emphasizing its significance in preserving bone density.

Effects on Bone Health

The impact of menopause on bone health is striking. Vertebral bone loss within the first two years post-menopause is, on average, 7.4%, with an average loss of 5.8% at the femoral neck. While the absolute loss of bone mineral density is somewhat less in obese women, it's crucial to understand that the relationship between bone health and obesity is intricate and does not guarantee protection against fragility fractures.

Ethnic differences in bone resorption changes, while attenuated, persist even after adjusting for body mass index (BMI). Combined with age-related declines in intestinal calcium absorption, vitamin D deficiency, and impaired synthesis of active 1,25-dihydroxy vitamin D3, these factors collectively contribute to osteoporosis and the heightened likelihood of fragility fractures.

Estrogen Insufficiency and Sarcopenia

Sarcopenia, the age-related loss of muscle mass and function, is further exacerbated by estrogen insufficiency during menopause. Estrogen, through its receptors in skeletal muscle stem cells (satellite cells), stimulates satellite cell proliferation in response to muscle damage. However, this effect diminishes with the decline in estrogen levels during menopause.

Moreover, menopause leads to an increase in visceral fat, resulting in the production of proinflammatory cytokines, which have adverse effects on skeletal muscle function and regeneration. Estrogen receptor alpha (ERα) plays a critical role in maintaining muscle mitochondrial and metabolic health. In a mouse model, ERα deletion leads to impaired insulin signaling, glucose disposal, increased inflammation, and fat infiltration. Thus, the metabolic consequences of estrogen insufficiency are closely intertwined with adverse effects on skeletal muscle.

Estrogen Treatment and Musculoskeletal Health

Estrogen treatment, with or without a progestogen, offers protection against postmenopausal vertebral and nonvertebral fractures. These protective effects extend to women with and without normal bone mineral density. However, it's essential to note that evidence supporting estrogen's protective role against sarcopenia is currently lacking. The primary approach to preventing sarcopenia is maintaining quality nutrition, with adequate protein intake, and regular physical exercise, including resistance training.

Cognition and Menopause

Cognitive changes are common during menopause, with women often experiencing difficulties with word finding, short-term memory, and problem-solving. While these cognitive symptoms are well-documented, most women continue to function within the range of normal cognitive performance. VMS frequency has been positively associated with changes in cognitive performance. Additionally, disrupted sleep, a common menopausal complaint, adversely affects attention and working memory, further emphasizing the complex interplay between hormonal changes and cognitive function.

Early Menopause and Cognitive Concerns

Early menopause, especially due to bilateral oophorectomy before the age of 46, raises concerns about cognitive impairment in women over 50. Observational data suggest a 2-fold increase in the likelihood of mild cognitive impairment in such cases. However, estrogen therapy does not appear to reduce this risk, highlighting the need for more extensive longitudinal studies to better understand the impact of sex hormone depletion on cognitive performance.

The Transient Nature of Cognitive Changes

Despite the cognitive changes experienced during the natural menopause transition, they are typically transient and followed by recovery postmenopause. Clinical trials have not shown a significant benefit of menopausal hormone therapy on cognitive function in postmenopausal women. As a result, best practice guidelines discourage the use of hormone therapy solely for cognitive concerns or dementia prevention.

Supportive Care in the Workplace

Menopause can have a significant impact on a woman's experience in the workplace. Severe vasomotor symptoms, in particular, can affect daily activities and work performance. Studies have shown that moderate to severe vasomotor symptoms are associated with decreased work ability, with factors like full-time employment, supervisor support, and workplace temperature control influencing symptom reporting.

Supportive care in the workplace needs to consider various factors beyond menopause, including age, partnership status, BMI, caregiving responsibilities, housing stability, and psychosocial factors. Research in this area is essential, particularly for women in voluntary and caregiving roles and those working from home.

Current Therapeutic Options

While not all women require treatment for menopause-associated symptoms, various therapeutic options are available for those who do. Lifestyle optimization and addressing non-communicable disease risk factors are vital. However, many women turn to non-prescription remedies for initial symptom relief, even though effective treatment is available.

Complementary and Alternative Medicines

Complementary and alternative medicines (CAMs) are frequently sought after for menopausal symptom relief. However, scientific studies often reveal their limited efficacy. Phytoestrogen supplements and black cohosh, despite being widely advertised, have shown inconsistent results in clinical trials. These treatments do not consistently outperform placebos, and their use should be approached with caution due to potential side effects and varying product quality.

Non-Hormonal Prescription Therapy

Non-hormonal medications have demonstrated efficacy against vasomotor symptoms (VMS). Selective serotonin reuptake inhibitors/selective norepinephrine reuptake inhibitors (SSRI/SNRIs) have been systematically studied in randomized clinical trials. They offer relief for women with contraindications for hormone therapy, such as those with a history of breast cancer or thromboembolism. While they can alleviate symptoms, they may come with side effects like sexual dysfunction.

Non-Hormonal Options for Menopausal Vasomotor Symptoms

• Citalopram: Usual daily oral doses of 20–40 mg result in a 50% reduction in VMS. Side effects may include nausea, somnolence or insomnia, dry mouth, and dyspepsia.

• Desvenlafaxine: Daily doses of 100–150 mg achieve a 60% reduction in VMS. Possible side effects include nausea, dry mouth, insomnia/somnolence, constipation, high blood pressure, and sexual dysfunction.

• Escitalopram: At 10–20 mg daily, it leads to a 50% reduction in VMS, with potential side effects like nausea, insomnia, headache, and sexual dysfunction.

• Fluoxetine: A daily dosage of 10–20 mg results in a 50% reduction in VMS. Side effects may include nausea, insomnia, headache, and sexual dysfunction.

• Paroxetine Mesylate: While effective, it may have side effects.

A breakthrough in the understanding of vasomotor symptoms (VMS), such as hot flashes and night sweats, occurred with the discovery of specific neurotransmitters and neurons responsible for these symptoms. It was found that neurotransmitters like kisspeptin, neurokinin 3B (NK3B), and dynorphin are co-localized in what are called KNDy neurons in the infundibular nucleus of the hypothalamus. The linkage of variants in the tachykinin gene, which encodes NK3B, to VMS in postmenopausal women led to the development of NK3B antagonists for clinical use.

Clinical trials have shown that these antagonists can significantly reduce VMS, and the first NK3B antagonist, fezolinetant, was approved by the US Food and Drug Administration in May 2023 for the treatment of moderate to severe menopausal VMS. Dual agents that target both the NK1B and NK3B receptors and address multiple inflammatory pathways are also in development and show promise for treating VMS.

Non-Hormonal Approaches

For some women, hormonal therapy may not be an option due to contraindications, such as taking tamoxifen for breast cancer. In such cases, non-hormonal options are being explored. One such option is Que-122, a compound that targets the chemokine receptor CXCR4. In a phase 2 trial, it was shown to significantly reduce VMS in women taking either estrogen antagonist therapy or aromatase inhibitor therapy after breast cancer, with effects similar to NK3B antagonists.

Hormone Therapy Options

Hormone therapy (MHT) remains a primary approach for managing menopausal symptoms. The mainstay of MHT is estrogen, which can be prescribed alone for women who have had a hysterectomy or with a progestogen in non-hysterectomized women to protect against endometrial stimulation. There are various estrogen preparations available, including oral and non-oral options. Some of the standard estrogen doses and preparations include:

Oral Estrogen Preparations

• Conjugated estrogens: 0.3–1.25 mg

• 17β estradiol: 0.5–2 mg

• Estradiol valerate: 0.5–2 mg

• Estriol: 1–2 mg

Non-Oral Estrogen Preparations

• Transdermal estradiol hemihydrate patch: releases 25–100 mcg

• Estradiol hemihydrate gel: 0.5–1.5

• Estradiol gel: 0.75/pump (1–4 pumps/day)

• Estradiol hemihydrate skin spray: 1.53 mg/spray (1–3 sprays/day)

Non-oral estrogen preparations have the advantage of avoiding hepatic metabolism and maintaining a 1-to-1 ratio of circulating estradiol and estrone sulfate, reducing the risk of certain side effects associated with oral estrogen.

Progestogens

Progestogens are often prescribed in combination with estrogen to protect the endometrium. There are different progestogens available, including dydrogesterone, medroxyprogesterone acetate, norethisterone acetate, and more. The choice of progestogen can depend on individual factors and preferences.

Risk and Benefit Considerations

The decision to use hormone therapy involves assessing the risk and benefits for each individual. High cardiovascular disease (CVD) risk and known coronary heart disease may be contraindications for some. It's important to note that non-oral estrogen is preferred for women at increased risk of venous thromboembolic events (VTE) and CVD, including smokers and those with obesity or diabetes.

Research suggests that the choice of progestogen may influence the cardiovascular effects of estrogen therapy. For example, progesterone may be a better option in the setting of increased CVD risk compared to medroxyprogesterone acetate (MPA).

Menopausal Hormone Therapy and Breast Cancer Risk

The impact of MHT on breast cancer risk remains a topic of debate. Some studies have shown an increased risk with specific MHT regimens, while others have not. The choice of progestogen may also play a role in breast safety. Tibolone, a synthetic steroid with estrogenic, progestogenic, and androgenic effects, has been associated with a lower risk of breast cancer in some studies.

Individualized Approaches

The benefit-to-risk ratio of hormone therapy should be considered on an individual basis. It's essential to take into account factors such as age, time since menopause, and personal health history when making decisions about MHT.

Duration of Therapy

The duration of hormone therapy has evolved over the years. Initially, recommendations were to use the lowest effective dose for the shortest duration, but more recent guidelines suggest that the duration of therapy should be based on individual symptoms and benefit-risk evaluations. Extended duration therapy may be considered when other options are not suitable to prevent bone loss.

Selective Estrogen Receptor Modulators (SERMs)

SERMs are synthetic, non-steroidal hormones with variable effects on different target tissues. Raloxifene, for example, has been shown to reduce bone resorption, increase bone mineral density, and significantly decrease the risk of vertebral fractures. Bazedoxifene, a third-generation SERM, is associated with reduced vertebral fractures and improved bone mineral density in postmenopausal women with osteoporosis.

Ospemifene, another SERM, has beneficial effects on vaginal tissues and can alleviate vulvovaginal symptoms.

Postmenopausal Androgen Therapy

Some women may benefit from postmenopausal androgen therapy, which can address specific symptoms, including sexual dysfunction and vaginal atrophy.

Androgens are 19-carbon steroid hormones primarily associated with the development of male secondary sexual characteristics. Testosterone, considered the primary human androgen, is derived from precursors known as androstenedione and dehydroepiandrosterone (DHEA), both of which are categorized as pre-androgens. Interestingly, after menopause, testosterone is mainly produced in non-ovarian tissues from these pre-androgens.

In addition to its direct androgenic effects, testosterone also acts indirectly by converting into estradiol through a process known as aromatization.

Challenges in Research

Research into the role of testosterone in women has faced challenges due to the limitations of conventional immunoassays in measuring testosterone at the low concentrations present in women. Despite the availability of more accurate measurement methods like liquid/gas chromatography with tandem mass spectrometry, caution is necessary when interpreting blood testosterone levels in the context of clinical outcomes. This is because testosterone synthesis occurs in target tissues, influenced by factors like androgen receptor density, coactivators, corepressors, and other sex steroids.

Musculoskeletal and Cognitive Effects

Studies suggest that testosterone has an anabolic effect on musculoskeletal tissues, impacting both estrogen receptors (ERs) and androgen receptors (ARs). However, clinical trials exploring the impact of testosterone on musculoskeletal outcomes have yielded inconclusive results, often due to limitations like small sample sizes and short durations.

Similarly, research on the relationship between testosterone and cognitive function remains inconclusive. While some evidence suggests neuroprotective and anti-inflammatory effects of testosterone in the brain, the benefits on cognition are not well-established.

Cardiovascular Function and Breast Cancer Risk

Studies examining cardiovascular function in postmenopausal women do not support adverse effects of endogenous testosterone on lipids, vascular function, or cardiovascular disease (CVD) risk. Moreover, clinical trials of postmenopausal transdermal testosterone therapy have not shown an increased risk of breast cancer in the short term. However, research on longer-term effects is still needed to draw definitive conclusions.

The Indication for Testosterone Therapy

The one evidence-based indication for judicious testosterone supplementation in postmenopausal women is low sexual desire accompanied by personal distress, known as hypoactive sexual desire dysfunction (HSDD). International guidelines emphasize that there is insufficient evidence to support the use of testosterone therapy for any other symptoms, clinical conditions, or disease prevention in postmenopausal or premenopausal women with HSDD.

DHEA in Postmenopausal Women

DHEA, despite being an important precursor for postmenopausal testosterone production, has not demonstrated significant improvements in sexual function, mood, or alleviation of vasomotor symptoms (VMS) in randomized, placebo-controlled clinical trials.

Ovarian Tissue Preservation and Transplantation

Fertility preservation has made remarkable progress in recent years, offering women the chance to retain the potential for future pregnancies. Cryopreservation of ovarian tissue is a technique used in cases where swift gonadal tissue collection is needed, either to initiate cancer treatment promptly or when oocyte retrieval is not possible. This cryopreserved tissue can be reimplanted into the ovaries when clinical conditions allow, with subsequent resumption of estrogen and progesterone synthesis, ovulation, and menstrual cycles. This technique provides a renewed opportunity for pregnancy.

Delaying Menopause and Ethical Considerations

Recent developments in ovarian tissue cryopreservation propose delaying menopause in women with a family history of premature ovarian insufficiency (POI) or for women experiencing spontaneous menopause within the normal age range. However, this approach has sparked an ongoing ethical debate regarding the balance between benefits and risks, including costs.

Rejuvenation of Ovaries

Research into the ovarian microenvironment has highlighted the importance of growth and differentiating factors, as well as gonadal stem cells in regulating follicular development and ovulatory function. Various experimental approaches, such as injecting platelet-rich plasma or stem cells from sources like autologous fat tissue, bone marrow, or menstrual blood into the ovaries, aim to "rejuvenate" ovarian function. These approaches show promise primarily for fertility applications, and their role in the hormonal management of premature or physiological menopause remains uncertain.

Specific Treatment for Urogenital Atrophy

Urogenital atrophy symptoms can significantly affect a woman's sexual well-being, relationships, quality of life, self-esteem, and social interaction. Mild symptoms may respond to non-hormonal vaginal moisturizers, while vaginal estrogen therapies effectively alleviate various urogenital symptoms, including vaginal dryness, vulvar itching, atrophic vaginitis, and dyspareunia.

Different vaginal estrogen formulations are available, including estradiol, estriol, and conjugated equine estrogen (CE), each offered in various forms like tablets, creams, pessaries, or vaginal rings. Additionally, DHEA vaginal pessaries are available, offering an alternative approach by converting to testosterone and then to estradiol in vaginal tissues.

Systemic Absorption and Safety

The systemic absorption of vaginal estrogen therapies varies depending on factors such as estrogen potency, frequency, duration of use, and the vaginal condition. Studies indicate that the risk of systemic absorption is low with specific formulations.

Concurrent progestogen therapy is generally not recommended for endometrial protection in low-dose vaginal estrogen therapy, particularly based on safety data from trials of over one year. However, longer-term safety data are still needed.

Alternative Therapies

For those who cannot or prefer not to use vaginal estrogen therapy, there are alternative options. Ospemifene, a selective estrogen receptor modulator (SERM) with estrogenic effects in vaginal tissues, is approved for the treatment of dyspareunia and vaginal dryness in some countries.

Intravaginal Testosterone and Energy-Based Therapies

Intravaginal testosterone has been explored as a potential treatment for urogenital atrophy due to its role in vaginal health. However, the evidence is limited, and more robust studies are required to establish its efficacy and safety.

Energy-based therapies, such as fractional CO2 laser, erbium YAG laser, and radiofrequency devices, have shown promise in treating urogenital atrophy. While small clinical studies suggest benefits and safety, recent randomized controlled trials have not demonstrated superiority over sham therapy.

Managing Symptoms in Breast Cancer Survivors

For women with estrogen-sensitive cancers, lubricants and vaginal moisturizers are recommended as the first-line therapy. Tamoxifen, as a partial estrogen receptor agonist, is associated with a lower likelihood of vaginal dryness than aromatase inhibitors. While the safety of intravaginal estrogen, DHEA, and oral ospemifene in breast cancer survivors is still uncertain, treatment may be considered for those with severe symptoms after careful consultation with a breast cancer specialist.

Knowledge Gaps and Research Directions

Despite decades of research on menopause, there are still significant knowledge gaps. More research is needed to document the age of menopause onset, early menopause, symptom prevalence, and their health impacts, especially in low-income countries. Additionally, long-term studies are urgently required to assess the safety and efficacy of various hormone therapy formulations, as most existing data are limited to preparations used in specific studies.

Conclusion

Optimizing health during and after menopause is essential for women's overall well-being. While not all women experience bothersome menopausal symptoms, understanding the potential health impacts of the menopausal transition is crucial. Postmenopausal androgen therapy, along with various other treatment options, can play a pivotal role in improving the quality of life during this significant phase. Research continues to evolve, and the best course of action may vary for each individual.

In conclusion, postmenopausal androgen therapy, ovarian tissue preservation, and other related approaches are critical subjects of research and discussion. To stay informed about the latest developments in postmenopausal health and therapy, consult your healthcare provider and keep an eye on emerging research findings.

Reference Article

Davis, S. R., et al. (2023). Menopause—Biology, consequences, supportive care, and therapeutic options. Cell. doi.org/10.1016/j.cell.2023.08.016.

Image : Wikimedia Commons

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https://healthnewstrend.com/optimizing-postmenopausal-nutrition-evidence-based-strategies-for-body-composition-bone-health-and-cardiometabolic-risk-reduction

https://healthnewstrend.com/menopausal-symptoms-and-treatment-options

Medical disclaimer:

The information provided in this article is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.