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Symptoms of menopause — global prevalence, physiology and implications

Key Points

  • Menopausal symptoms have a substantial effect on the quality of life of women and on performance at the workplace; increased awareness of symptoms and acquisition of coping strategies might help

  • Certain menopausal symptoms might serve as markers for future health; severe vasomotor symptoms and sleep disorders might increase cardiovascular risk, whereas severe vasomotor symptoms and depression might affect cognitive function

  • The nature of menopausal symptoms is common to all women; however, geographical location and ethnicity influence the prevalence of certain symptoms

  • Individual factors such as personal history, current health status (particularly obesity) and socioeconomic status considerably worsen a woman's experience of menopause

  • Health-care providers should offer education to women on improving modifiable lifestyle factors to reduce the risk of future illness

  • Menopause seems to accelerate the ageing process; therefore, the manifestation of menopausal symptoms might be in part due to ageing

Abstract

The symptoms of menopause can be distressing, particularly as they occur at a time when women have important roles in society, within the family and at the workplace. Hormonal changes that begin during the menopausal transition affect many biological systems. Accordingly, the signs and symptoms of menopause include central nervous system-related disorders; metabolic, weight, cardiovascular and musculoskeletal changes; urogenital and skin atrophy; and sexual dysfunction. The physiological basis of these manifestations is emerging as complex and related, but not limited to, oestrogen deprivation. Findings generated mainly from longitudinal population studies have shown that ethnic, geographical and individual factors affect symptom prevalence and severity. Moreover, and of great importance to clinical practice, the latest research has highlighted how certain menopausal symptoms can be associated with the onset of other disorders and might therefore serve as predictors of future health risks in postmenopausal women. The goal of this Review is to describe in a timely manner new research findings on the global prevalence and physiology of menopausal symptoms and their impact on future health.

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Figure 1: Overview of menopausal symptoms.
Figure 2: Endocrine implications of menopausal symptoms and changes.

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Authors

Contributions

P.M., G.M. and A.G. researched data for the article. All authors made a substantial contribution to discussion of content, wrote the manuscript and reviewed and/or edited the manuscript before submission.

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Correspondence to Andrea R. Genazzani.

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PowerPoint slides

Glossary

Hot flashes

A sudden wave of body heat accompanied by reddening of the face and neck and profuse sweating, sometimes followed by a feeling of cold and shivering.

Ovarian failure

The definite loss of function of the ovaries.

Postmenopause

The period of a woman's life that follows the final menstrual period.

Perimenopause

The period of a woman's life that encompasses the menopausal transition and the first year following the final menstrual period.

Amenorrhoea

The absence of menstrual periods for 3 or more consecutive months in a woman of reproductive age.

Obstructive sleep apnoea

A sleeping disorder caused by repetitive upper airway collapse during sleep, leading to intermittent hypoxia and characterized by loud snoring, apnoea during sleep, insomnia, excessive daytime sleepiness, morning headache and fatigue.

Surgical menopause

Menopause induced by the surgical removal of the ovaries.

Visceral adiposity

Accumulation of adipose tissue in the abdomen and around internal organs.

Premenstrual syndrome

A heterogeneous group of emotional symptoms, such as irritability and food cravings, and physical symptoms, such as bloating, breast tenderness and abdominal pain, that precede the menstrual period.

Anovulation

The absence of ovulation.

Urethral closure pressure

The fluid pressure needed to open a closed urethra.

Valsalva leak-point pressure

The lowest abdominal pressure required during a stress activity that causes the urethra to open and leak.

Free androgen index

An index that represents the ratio of bioactive circulating testosterone.

Cardiac vagal control

An index of parasympathetic contribution to cardiac regulation.

Cardiac index

The volume of blood pumped by the heart in a minute per body surface.

Stroke volume index

The volume of blood pumped by the heart with each beat per body surface.

Vascular resistance index

An index representing the degree to which blood vessels impede the flow of blood.

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Monteleone, P., Mascagni, G., Giannini, A. et al. Symptoms of menopause — global prevalence, physiology and implications. Nat Rev Endocrinol 14, 199–215 (2018). https://doi.org/10.1038/nrendo.2017.180

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