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The menopausal transition is a progressive endocrinologic continuum that takes reproductive-aged women from regular, cyclic, and predictable menses that are characteristic of ovulatory cycles, to a final menstrual period associated with ovarian senescence. With improvements in medical treatment and increased focus on preventive health care, average life expectancy has increased. As a result, most women can now expect to live at least one third of their lives in the postmenopause. Specifically, in the 2010 United States census, nearly 42 million women were aged 55 years and older (U.S. Census Bureau, 2011). Importantly, menopausal transition and the years of life spent in the postmenopausal state bring with them issues related to both quality of life and disease prevention and management (Lund, 2008).


The term menopause refers to a point in time that follows 1 year after the cessation of menstruation. The postmenopause describes those years following this point. The average age of women experiencing their final menstrual period is 51.5 years, but cessation of menses due to ovarian failure may occur at any age. Premature ovarian failure refers to cessation of menses before age 40 and is associated with an elevated follicle-stimulating hormone (FSH) level (Chap. 16). The older terms perimenopause or climacteric generally refer to the time period in the late reproductive years, usually late 40s to early 50s. Characteristically, it begins with menstrual cycle irregularity and extends to 1 year after permanent cessation of menses. The more correct terminology for this time is menopausal transition. This transition typically develops over a span of 4 to 7 years, and the average age at its onset is 47 years (Burger, 2008; McKinlay, 1992).


The first standardized classification guidelines for female reproductive aging were proposed in 2001 at the Stages of Reproductive Aging workshop (STRAW) (Fig. 21-1). The purpose of the STRAW report was to clarify the stages and nomenclature of normal female reproductive aging. These staging criteria are intended to be guidelines rather than strictly applied diagnoses. Every stage may not occur in a given individual, and if they do occur, they may not progress in the exact sequence provided (Hale, 2009). The group concluded that because the terms perimenopause and climacteric are not used consistently, they should be used only with patients and in the lay press and not in scientific papers. The term menopausal transition is the preferred term (Soules, 2001).

Figure 21-1
Graphic Jump Location

The stages of reproductive aging. Amen = Amenorrhea; FSH = follicle-stimulating hormone level. (Redrawn from Soules, 2001, with permission).


The STRAW report divides reproductive and postreproductive life into several stages. The anchor for the staging system is the final menstrual period (FMP), and the age range and duration of each stage varies. Five stages precede and two stages follow the ...

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