Menopause and climacteric syndrome !

Menopause is the last menstrual period, when the ovaries stop working. The years around it bring hot flushes, sleep and mood changes, and bone loss.

Updated 2026-11-01

Structures involved

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Why it happens

What it is

Menopause is the permanent end of menstruation caused by loss of ovarian follicular activity, confirmed retrospectively after 12 months without periods. The climacteric is the wider transition around it, and climacteric syndrome is the set of symptoms that can accompany it.

Who gets it

Natural menopause usually occurs between 45 and 55 years; Latin American studies suggest an average age around the late 40s, slightly earlier than in high-income countries. With longer life expectancy, women in Colombia live about a third of their lives after menopause, so its long-term effects on bone and heart health matter for public health.

Causes

Natural depletion of ovarian follicles with age
Surgical: removal of both ovaries
Iatrogenic: chemotherapy or pelvic radiotherapy
Premature menopause before 40 (see primary ovarian insufficiency)

Risk factors

Smoking (earlier menopause)
Family history of early menopause
Low body weight
Previous ovarian surgery or cancer treatment

Pathophysiology

As follicles run out, inhibin and oestradiol fall and the pituitary raises FSH, then LH, through loss of negative feedback. Cycles become irregular and anovulatory during perimenopause until menstruation stops. Low oestrogen alters hypothalamic thermoregulation (hot flushes), thins the vaginal and urinary epithelium, accelerates bone resorption and removes a favourable effect on lipids and blood vessels.

Classification

Perimenopause (menopausal transition)
Menopause (final menstrual period)
Postmenopause (early and late)
Natural, surgical or induced menopause
Premature (before 40) and early (40 to 45) menopause

Symptoms and signs

Irregular periods, then amenorrhoea
Hot flushes and night sweats (vasomotor symptoms)
Sleep disturbance
Mood changes, irritability, poor concentration
Vaginal dryness and pain with intercourse
Urinary urgency and recurrent urinary infections
Joint pain and lower libido

Diagnosis

Clinical: Clinical in a woman over 45 with typical symptoms and 12 months without periods; laboratory tests are usually unnecessary.
Tests: FSH (high) and oestradiol (low) only in selected cases, such as women under 45 or suspected premature ovarian insufficiency. TSH and a pregnancy test when the picture is unclear. Lipids, glucose and cardiovascular risk assessment as part of midlife care.
Imaging: Bone densitometry (DXA) to assess osteoporosis according to age and risk; transvaginal ultrasound if there is postmenopausal bleeding.

Differential diagnosis

Pregnancy
Thyroid disease (hyperthyroidism)
Hyperprolactinaemia
Primary ovarian insufficiency
Depression or anxiety disorder
Medication side effects (flushing)

Goal of treatment

Relieve troublesome symptoms, protect bone and cardiovascular health, and support quality of life, choosing the safest option for each woman after weighing benefits and risks.

Treatment

Lifestyle: Regular exercise, healthy weight, not smoking, limiting alcohol and caffeine, cool environment and sleep hygiene; adequate calcium and vitamin D for bone health.
Medical: Menopausal hormone therapy is the most effective treatment for vasomotor symptoms: oestrogen alone after hysterectomy, oestrogen plus a progestogen when the uterus is present, ideally started before 60 or within 10 years of menopause.
Medical: Non-hormonal options when hormones are contraindicated or declined: SSRIs or SNRIs, gabapentin, and neurokinin-3 receptor antagonists such as fezolinetant.
Medical: Low-dose vaginal oestrogen or vaginal moisturisers and lubricants for genitourinary symptoms.
Follow-up: Periodic review of the need to continue therapy, breast and cervical screening, blood pressure, and bone density according to risk.

Complications

Osteoporosis and fragility fractures
Increased cardiovascular risk
Genitourinary syndrome of menopause
Sleep and mood disorders
Hormone therapy risks: venous thromboembolism, stroke, breast cancer with long combined use

Prognosis

Vasomotor symptoms usually last several years and then fade, though some women have them much longer. Genitourinary changes tend to persist without treatment. Long-term health depends mostly on bone and cardiovascular prevention.

Prevention

Bone health: physical activity, calcium, vitamin D, no smoking
Cardiovascular risk control (blood pressure, lipids, glucose, weight)
Evaluation of any postmenopausal bleeding

Test yourself

Think of the answer, then tap the question to see it.

How is natural menopause defined?

Twelve consecutive months without menstruation, with no other cause, due to loss of ovarian follicular function.

Which pituitary hormone rises first and most in menopause?

FSH, because inhibin and oestradiol from the ovarian follicles fall.

Why must a progestogen be added to oestrogen therapy in a woman with a uterus?

To prevent endometrial hyperplasia and endometrial cancer caused by unopposed oestrogen.

What are three contraindications to menopausal hormone therapy?

Breast or endometrial cancer, unexplained vaginal bleeding, and history of venous thromboembolism, stroke or coronary disease (also active liver disease).

What symptom after menopause always needs evaluation?

Postmenopausal vaginal bleeding, to exclude endometrial hyperplasia or cancer.

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Educational information, not medical advice. For any symptom, see a health professional.

Sources: Menopause (World Health Organization, 2024); Menopause (MedlinePlus (U.S. National Library of Medicine), 2024).

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Representative model, for educational purposes only.

Ovaries highlighted on the Durgical 3D model