Hastened ovarian aging has been observed after endometrial ablation. While it is difficult to prove that these surgeries are causative, it has been hypothesized that the endometrium may be producing endocrine factors contributing to the endocrine feedback and regulation of the ovarian stimulation. Elimination of this factors contributes to faster depletion of the ovarian reserve.
Reduced blood supply to the ovaries that may occur as a consequence of hysterectomy and uterine artery embolisation has been hypothesized to contribute to this effect. Impaired DNA repair mechanisms may contribute to earlier depletion of the ovarian reserve during aging.
Primordial follicles are immature primary oocytes surrounded by a single layer of granulosa cells. An enzyme system is present in oocytes that ordinarily accurately repairs DNA double-strand breaks.
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This repair system is called " homologous recombinational repair", and it is especially effective during meiosis. Meiosis is the general process by which germ cells are formed in all sexual eukaryotes; it appears to be an adaptation for efficiently removing damages in germ line DNA. Human primary oocytes are present at an intermediate stage of meiosis, termed prophase I see Oogenesis.
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Ways of assessing the impact on women of some of these menopause effects, include the Greene climacteric scale questionnaire,  the Cervantes scale  and the Menopause rating scale. Premenopause is a term used to mean the years leading up to the last period, when the levels of reproductive hormones are becoming more variable and lower, and the effects of hormone withdrawal are present. The term "perimenopause", which literally means "around the menopause", refers to the menopause transition years before the date of the final episode of flow.
The official date is determined retroactively, once 12 months have passed after the last appearance of menstrual blood. The menopause transition typically begins between 40 and 50 years of age average In some women, menopause may bring about a sense of loss related to the end of fertility.
In addition, this change often occurs when other stressors may be present in a woman's life:. Some research appears to show that melatonin supplementation in perimenopausal women can improve thyroid function and gonadotropin levels, as well as restoring fertility and menstruation and preventing depression associated with menopause. The term "postmenopausal" describes women who have not experienced any menstrual flow for a minimum of 12 months, assuming that they have a uterus and are not pregnant or lactating.
Thus postmenopause is the time in a woman's life that takes place after her last period or, more accurately, after the point when her ovaries become inactive. The reason for this delay in declaring postmenopause is because periods are usually erratic at this time of life. Therefore, a reasonably long stretch of time is necessary to be sure that the cycling has ceased.
At this point a woman is considered infertile; however, the possibility of becoming pregnant has usually been very low but not quite zero for a number of years before this point is reached.
A woman's reproductive hormone levels continue to drop and fluctuate for some time into post-menopause, so hormone withdrawal effects such as hot flashes may take several years to disappear. A period-like flow during postmenopause, even spotting, may be a sign of endometrial cancer. Perimenopause is a natural stage of life.
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It is not a disease or a disorder. Therefore, it does not automatically require any kind of medical treatment. However, in those cases where the physical, mental, and emotional effects of perimenopause are strong enough that they significantly disrupt the life of the woman experiencing them, palliative medical therapy may sometimes be appropriate. In the context of the menopause, hormone replacement therapy HRT is the use of estrogen in women without a uterus and estrogen plus progestin in women who have an intact uterus. HRT may be reasonable for the treatment of menopausal symptoms, such as hot flashes.
It also appears effective for preventing bone loss and osteoporotic fracture,  but it is generally recommended only for women at significant risk for whom other therapies are unsuitable. HRT may be unsuitable for some women, including those at increased risk of cardiovascular disease, increased risk of thromboembolic disease such as those with obesity or a history of venous thrombosis or increased risk of some types of cancer.
Adding testosterone to hormone therapy has a positive effect on sexual function in postmenopausal women, although it may be accompanied by hair growth, acne and a reduction in high-density lipoprotein HDL cholesterol. SERMs are a category of drugs, either synthetically produced or derived from a botanical source, that act selectively as agonists or antagonists on the estrogen receptors throughout the body.
The most commonly prescribed SERMs are raloxifene and tamoxifen. Raloxifene exhibits oestrogen agonist activity on bone and lipids, and antagonist activity on breast and the endometrium. Raloxifene prevents vertebral fractures in postmenopausal, osteoporotic women and reduces the risk of invasive breast cancer. Gabapentin or clonidine may help but do not work as well as hormone therapy. Side effects associated with its use include drowsiness and headaches. Clonidine is used to improve vasomotor symptoms and may be associated with constipation, dizziness, nausea and sleeping problems.
One review found mindfulness and cognitive behavioural therapy decreases the amount women are affected by hot flushes. Exercise has been thought to reduce postmenopausal symptoms through the increase of endorphin levels, which decrease as estrogen production decreases. However, there is insufficient evidence to support the benefits of weight loss for symptom management. While one review found that there was a lack of quality evidence supporting a benefit of exercise,  another review recommended regular healthy exercise to reduce comorbidities, improve mood and anxiety symptoms, enhance cognition, and decrease the risk of fractures.
There is no evidence of consistent benefit of alternative therapies for menopausal symptoms despite their popularity. The effect of soy isoflavones on menopausal symptoms is promising for reduction of hot flashes and vaginal dryness. Hypnosis may reduce the severity of hot flashes. In addition, relaxation training with at-home relaxation audiotapes such as deep breathing, paced respiration, and guided imagery may have positive effects on relaxing muscles and reducing stress.
There is no evidence to support the efficacy of acupuncture as a management for menopausal symptoms. The cultural context within which a woman lives can have a significant impact on the way she experiences the menopausal transition.
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Menopause has been described as a subjective experience, with social and cultural factors playing a prominent role in the way menopause is experienced and perceived. The word menopause was invented by French doctors at the beginning of the nineteenth century. Some of them noted that peasant women had no complaints about the end of menses, while urban middle class women had many troubling symptoms. Doctors at this time considered the symptoms to be the result of urban lifestyles of sedentary behaviour, alcohol consumption, too much time indoors, and over-eating, with a lack of fresh fruit and vegetables.
Research indicates that whether a woman views menopause as a medical issue or an expected life change is correlated with her socio-economic status. Ethnicity and geography play roles in the experience of menopause. American women of different ethnicities report significantly different types of menopausal effects. One major study found Caucasian women most likely to report what are sometimes described as psychosomatic symptoms, while African-American women were more likely to report vasomotor symptoms.
It seems that Japanese women experience menopause effects, or konenki , in a different way from American women. Historically, konenki was associated with wealthy middle-class housewives in Japan, i. Menopause in Japan was viewed as a symptom of the inevitable process of aging, rather than a "revolutionary transition", or a "deficiency disease" in need of management. In Japanese culture, reporting of vasomotor symptoms has been on the increase, with research conducted by Melissa Melby in finding that of Japanese participants, hot flashes were prevalent in Additionally, while most women in the United States apparently have a negative view of menopause as a time of deterioration or decline, some studies seem to indicate that women from some Asian cultures have an understanding of menopause that focuses on a sense of liberation and celebrates the freedom from the risk of pregnancy.
This is a medical calque ; the Greek word for menses is actually different. The word "menopause" was coined specifically for human females, where the end of fertility is traditionally indicated by the permanent stopping of monthly menstruations. However, menopause exists in some other animals, many of which do not have monthly menstruation;  in this case, the term means a natural end to fertility that occurs before the end of the natural lifespan. Various theories have been suggested that attempt to suggest evolutionary benefits to the human species stemming from the cessation of women's reproductive capability before the end of their natural lifespan.
Explanations can be categorized as adaptive and non-adaptive:. The high cost of female investment in offspring may lead to physiological deteriorations that amplify susceptibility to becoming infertile.
This hypothesis suggests the reproductive lifespan in humans has been optimized, but it has proven more difficult in females and thus their reproductive span is shorter. If this hypothesis were true, however, age at menopause should be negatively correlated with reproductive effort  and the available data do not support this.
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A recent increase in female longevity due to improvements in the standard of living and social care has also been suggested. In other words, senescence is programmed and regulated by specific genes. While it is fairly common for extant hunter-gatherers to live past age 50 provided that they survive childhood, fossil evidence shows that mortality in adults has decreased over the last to years and that it was extremely unusual for early Homo sapiens to live to age This discovery has led some biologists to argue that there was no selection for or against menopause at the time at which the ancestor of all modern humans lived in Africa, suggesting that menopause is instead a random evolutionary effect of a selection shadow regarding ageing in early Homo sapiens.
It is also argued that since the population fraction of post-menopausal women in early Homo sapiens was so low, menopause had no evolutionary effect on mate selection or social behaviors related to mate selection.
This hypothesis suggests that younger mothers and offspring under their care will fare better in a difficult and predatory environment because a younger mother will be stronger and more agile in providing protection and sustenance for herself and a nursing baby. The various biological factors associated with menopause had the effect of male members of the species investing their effort with the most viable of potential female mates.