Menopause before the age of 45 years is considered to be "early menopause" and when ovarian failure/surgical removal of the ovaries occurs before the age of 40 years this is termed "premature ovarian insufficiency".In addition symptoms (hot flushes/flashes, night sweats, mood changes, arthralgia and vaginal dryness) the physical consequences of menopause include bone loss, increased central abdominal fat, and adverse changes in a womans cholesterol profile and vascular function. These changes predispose postmenopausal women to increased risks of osteoporosis and fracture and cardio-metabolic disease (diabetes and cardiovascular disease).Menopause is usually a natural change. It can occur earlier in those who smoke tobacco. Other causes include surgery that removes both ovaries or some types of chemotherapy. At the physiological level, menopause happens because of a decrease in the ovaries production of the hormones estrogen and progesterone. While typically not needed, a diagnosis of menopause can be confirmed by measuring hormone levels in the blood or urine. Menopause is the opposite of menarche, the time when a girls periods start.The primary indications for treatment of menopause are symptoms and prevention of bone loss. Mild symptoms, however, may be improved with treatment. With respect to hot flashes, avoiding smoking, caffeine, and alcohol is often recommended. Sleeping in a cool room and using a fan may help. The most effective treatment for menopausal symptoms is menopausal hormone therapy (MHT). Non hormonal therapies for hot flushes/flashes include clonidine, gabapentin, or selective serotonin reuptake inhibitors.
However, in about 50–80% of cases of premature ovarian insufficiency, the cause is unknown, i.e., it is generally idiopathic.An early menopause can be related to cigarette smoking, higher body mass index, racial and ethnic factors, illnesses, and the removal of the uterus.Rates of premature menopause have been found to be significantly higher in fraternal and identical twins; approximately 5% of twins reach menopause before the age of 40. The reasons for this are not completely understood. Transplants of ovarian tissue between identical twins have been successful in restoring fertility. Surgical menopause
Menopause can be surgically induced by bilateral oophorectomy (removal of ovaries), which is often, but not always, done in conjunction with removal of the Fallopian tubes (salpingo-oophorectomy) and uterus (hysterectomy). Cessation of menses as a result of removal of the ovaries is called "surgical menopause". Surgical treatments, such as the removal of ovaries, might cause periods to stop altogether. The sudden and complete drop in hormone levels may produce extreme withdrawal symptoms such as hot flashes, etc. The symptoms of early menopause may be more severe.Removal of the uterus without removal of the ovaries does not directly cause menopause, although pelvic surgery of this type can often precipitate a somewhat earlier menopause, perhaps because of a compromised blood supply to the ovaries. The time between surgery and possible early menopause is due to the fact that ovaries are still producing hormones. Mechanism
The menopausal transition, and postmenopause itself, is a natural change, not usually a disease state or a disorder.