Menopause - Wikipedia

Menopause, also known as the climacteric, is the time in women's lives when menstrual periods stop permanently, and they are no longer able to bear children ... Menopause FromWikipedia,thefreeencyclopedia Jumptonavigation Jumptosearch Timewhenmenstrualperiodsstoppermanently Thisarticleisabouttheconditionaffectingwomen.Fortheconditioncalledmalemenopause,seeAndropause.Forthemedicaljournal,seeMenopause(journal). MedicalconditionMenopauseOthernamesClimactericSpecialtyGynecologySymptomsNomenstrualperiodsforayear[1]Duration~3yearCausesUsuallyanaturalchange.Canalsobecausedbysurgerythatremovesbothovariesandsometypesofchemotherapy.[2][3]TreatmentNone,lifestylechanges[4]MedicationMenopausalhormonetherapy,clonidine,gabapentin,selectiveserotoninreuptakeinhibitors[4][5] Menopause,alsoknownastheclimacteric,isthetimeinwomen'sliveswhenmenstrualperiodsstoppermanently,andtheyarenolongerabletobearchildren.[1][7]Menopauseusuallyoccursbetweentheageof47and54.[6]Medicalprofessionalsoftendefinemenopauseashavingoccurredwhenawomanhasnothadanymenstrualbleedingforayear.[2]Itmayalsobedefinedbyadecreaseinhormoneproductionbytheovaries.[8]Inthosewhohavehadsurgerytoremovetheiruterusbutstillhaveovaries,menopausemaybeconsideredtohaveoccurredatthetimeofthesurgeryorwhentheirhormonelevelsfell.[8]Followingtheremovaloftheuterus,symptomstypicallyoccurearlier,atanaverageof45yearsofage.[9] Intheyearsbeforemenopause,awoman'speriodstypicallybecomeirregular,[10][11]whichmeansthatperiodsmaybelongerorshorterindurationorbelighterorheavierintheamountofflow.[10]Duringthistime,womenoftenexperiencehotflashes;thesetypicallylastfrom30secondstotenminutesandmaybeassociatedwithshivering,sweating,andreddeningoftheskin.[10]Hotflashescanlastfromfourtofiveyears.[7]Othersymptomsmayincludevaginaldryness,troublesleeping,andmoodchanges.[10]Theseverityofsymptomsvariesbetweenwomen.[7]Whilemenopauseisoftenthoughttobelinkedtoanincreaseinheartdisease,thisprimarilyoccursduetoincreasingageanddoesnothaveadirectrelationshipwithmenopause.[7]Insomewomen,problemsthatwerepresentlikeendometriosisorpainfulperiodswillimproveaftermenopause.[7] Menopauseisusuallyanaturalchange.[3]Itcanoccurearlierinthosewhosmoketobacco.[2][12]Othercausesincludesurgerythatremovesbothovariesorsometypesofchemotherapy.[2]Atthephysiologicallevel,menopausehappensbecauseofadecreaseintheovaries'productionofthehormonesestrogenandprogesterone.[1]Whiletypicallynotneeded,adiagnosisofmenopausecanbeconfirmedbymeasuringhormonelevelsinthebloodorurine.[13]Menopauseistheoppositeofmenarche,thetimewhenagirl'speriodsstart.[14] Specifictreatmentisnotusuallyneeded.[4]Somesymptoms,however,maybeimprovedwithtreatment.[4]Withrespecttohotflashes,avoidingsmoking,caffeine,andalcoholisoftenrecommended.[4]Sleepinginacoolroomandusingafanmayhelp.[4]Thefollowingmedicationsmayhelp:menopausalhormonetherapy(MHT),clonidine,gabapentin,orselectiveserotoninreuptakeinhibitors.[4][5]Exercisemayhelpwithsleepingproblems.[4]WhileMHTwasonceroutinelyprescribed,itisnowonlyrecommendedinthosewithsignificantsymptoms,asthereareconcernsaboutsideeffects.[4]High-qualityevidencefortheeffectivenessofalternativemedicinehasnotbeenfound.[7]Thereistentativeevidenceforphytoestrogens.[15] Contents 1Signsandsymptoms 1.1Vaginaanduterus 1.2Otherphysical 1.3Moodandmemoryeffects 1.4Long-termeffects 2Causes 2.1Age 2.2Prematureovarianfailure 2.3Surgicalmenopause 3Mechanism 3.1Ovarianaging 4Diagnosis 4.1Premenopause 4.2Perimenopause 4.3Postmenopause 5Management 5.1Hormonereplacementtherapy 5.2Selectiveestrogenreceptormodulators 5.3Othermedications 5.4Therapy 5.5Exercise 5.6Alternativemedicine 5.7Otherefforts 6Societyandculture 6.1Etymology 6.2Menopauseinpopularculture 7Evolutionaryrationale 7.1Non-adaptivehypotheses 7.1.1Earlyhumanselectionshadow 7.2Adaptivehypotheses 7.2.1"Survivalofthefittest"hypothesis 7.2.2Youngfemalepreferencehypothesis 7.2.3Male-biasedphilopatryhypothesis 7.2.4Motherhypothesis 7.2.5Grandmotherhypothesis 7.2.5.1Reproductiveconflicthypothesis 8Otheranimals 9Seealso 10References 11Externallinks Signsandsymptoms[edit] Symptomsofmenopause Duringearlymenopausetransition,themenstrualcyclesremainregularbuttheintervalbetweencyclesbeginstolengthen.Hormonelevelsbegintofluctuate.Ovulationmaynotoccurwitheachcycle.[16] Thetermmenopausereferstoapointintimethatfollowsoneyearafterthelastmenstruation.[16]Duringthemenopausaltransitionandaftermenopause,womencanexperienceawiderangeofsymptoms. Vaginaanduterus[edit] Sizeofthevaginalcanalbeforeandaftermenopause,demonstratingvaginalatrophy. Duringthetransitiontomenopause,menstrualpatternscanshowshortercycling(by2–7days);[16]longercyclesremainpossible.[16]Theremaybeirregularbleeding(lighter,heavier,spotting).[16]Dysfunctionaluterinebleedingisoftenexperiencedbywomenapproachingmenopauseduetothehormonalchangesthataccompanythemenopausetransition.Spottingorbleedingmaysimplyberelatedtovaginalatrophy,abenignsore(polyporlesion),ormaybeafunctionalendometrialresponse.TheEuropeanMenopauseandAndropauseSocietyhasreleasedguidelinesforassessmentoftheendometrium,whichisusuallythemainsourceofspottingorbleeding.[17] Inpost-menopausalwomen,however,anygenitalbleedingisanalarmingsymptomthatrequiresanappropriatestudytoruleoutthepossibilityofmalignantdiseases. Symptomsthatmayappearduringmenopauseandcontinuethroughpostmenopauseinclude: painfulintercourse[16] vaginaldryness[16] atrophicvaginitis–thinningofthemembranesofthevulva,thevagina,thecervix,andtheouterurinarytract,alongwithconsiderableshrinkingandlossinelasticityofalloftheouterandinnergenitalareas. Otherphysical[edit] Thissectionmaycontainanexcessivenumberofcitations.Pleaseconsiderremovingreferencestounnecessaryordisreputablesources,mergingcitationswherepossible,or,ifnecessary,flaggingthecontentfordeletion.(September2021)(Learnhowandwhentoremovethistemplatemessage) Bonemineraldensity,especiallyofthevertebrae,decreaseswithmenopause Otherphysicalsymptomsofmenopauseincludelackofenergy,jointsoreness,stiffness,backpain,breastenlargement,breastpain, heartpalpitations,headache,dizziness,dry,itchyskin,thinning,tinglingskin,[16]rosacea,[18]weightgain,[16]urinaryincontinence,[16][19] urinaryurgency,[16] interruptedsleepingpatterns,[16][20][21][22]heavynightsweats,[16]andhotflashes.[16] Moodandmemoryeffects[edit] Psychologicalsymptomsincludeanxiety,poormemory,inabilitytoconcentrate,depressivemood,irritability,moodswings,andlessinterestinsexualactivity.[16][23] Menopause-relatedcognitiveimpairmentcanbeconfusedwiththemildcognitiveimpairmentthatprecedesdementia.[24]Tentativeevidencehasfoundthatforgetfulnessaffectsabouthalfofmenopausalwomen[25]andisprobablycausedbytheeffectsofdecliningestrogenlevelsonthebrain,[25]orperhapsbyreducedbloodflowtothebrainduringhotflashes.[26] Long-termeffects[edit] Menopauseconfers: Apossiblebutcontentiousincreasedriskofatherosclerosis.[27]Theriskofacutemyocardialinfarctionandothercardiovasculardiseasesrisessharplyaftermenopause,buttheriskcanbereducedbymanagingriskfactors,suchastobaccosmoking,hypertension,increasedbloodlipidsandbodyweight.[28][29] Increasedriskofosteopenia,osteoporosis,[30]andacceleratedlungfunctiondecline.[31][32] Womenwhoexperiencemenopausebefore45yearsofagehaveanincreasedriskofheartdisease,[33]death,[34]andimpairedlungfunction.[31] Causes[edit] Menopausecanbeinducedoroccurnaturally.Inducedmenopauseoccursasaresultofmedicaltreatmentsuchaschemotherapy,radiotherapy,oophorectomy,orcomplicationsoftuballigation,hysterectomy,unilateralorbilateralsalpingo-oophorectomyorleuprorelinusage.[35] Age[edit] Menopausetypicallyoccursbetween47and54yearsofage.[6]Accordingtovariousdata,morethan85%ofwomenhavetheirlastperiodbetweentheagesof47-54(median49–50).2%ofwomenundertheageof40,5%betweentheagesof40-45andthesamenumberbetweentheagesof55-58havetheirlastbleeding.[36]TheaverageageofthelastperiodintheUnitedStatesis51years,inRussiais50years,inGreeceis49years,inTurkeyis47years,inEgyptis47yearsandinIndiais46years.[37]Themenopausaltransitionorperimenopauseleadinguptomenopauseusuallylasts3–4years(sometimesaslongas5–14years).[1][11] Inrarecases,awoman'sovariesstopworkingataveryearlyage,ranginganywherefromtheageofpubertytoage40.Thisisknownasprematureovarianfailureandaffects1to2%ofwomenbyage40.[38] Undiagnosedanduntreatedcoeliacdiseaseisariskfactorforearlymenopause.Coeliacdiseasecanpresentwithseveralnon-gastrointestinalsymptoms,intheabsenceofgastrointestinalsymptoms,andmostcasesescapetimelyrecognitionandgoundiagnosed,leadingtoariskoflong-termcomplications.Astrictgluten-freedietreducestherisk.Womenwithearlydiagnosisandtreatmentofcoeliacdiseasepresentanormaldurationoffertilelifespan.[39][40] Womenwhohaveundergonehysterectomywithovaryconservationgothroughmenopauseonaverage3.7yearsearlierthantheexpectedage.Otherfactorsthatcanpromoteanearlieronsetofmenopause(usually1to3yearsearly)aresmokingcigarettesorbeingextremelythin.[41] Prematureovarianfailure[edit] Prematureovarianfailure(POF)iswhentheovariesstopfunctioningbeforetheageof40years.[42][43]Itisdiagnosedorconfirmedbyhighbloodlevelsoffolliclestimulatinghormone(FSH)andluteinizinghormone(LH)onatleastthreeoccasionsatleastfourweeksapart.[44] Knowncausesofprematureovarianfailureincludeautoimmunedisorders,thyroiddisease,diabetesmellitus,chemotherapy,beingacarrierofthefragileXsyndromegene,andradiotherapy.[43]However,inabout50–80%ofspontaneouscasesofprematureovarianfailure,thecauseisunknown,i.e.,itisgenerallyidiopathic.[42][44] Womenwhohaveafunctionaldisorderaffectingthereproductivesystem(e.g.,endometriosis,polycysticovarysyndrome,cancerofthereproductiveorgans)cangointomenopauseatayoungeragethanthenormaltimeframe.Thefunctionaldisordersoftensignificantlyspeedupthemenopausalprocess. Anearlymenopausecanberelatedtocigarettesmoking,higherbodymassindex,racialandethnicfactors,illnesses,andthesurgicalremovaloftheovaries,withorwithouttheremovaloftheuterus.[45] Ratesofprematuremenopausehavebeenfoundtobesignificantlyhigherinfraternalandidenticaltwins;approximately5%oftwinsreachmenopausebeforetheageof40.Thereasonsforthisarenotcompletelyunderstood.Transplantsofovariantissuebetweenidenticaltwinshavebeensuccessfulinrestoringfertility. Surgicalmenopause[edit] Menopausecanbesurgicallyinducedbybilateraloophorectomy(removalofovaries),whichisoften,butnotalways,doneinconjunctionwithremovaloftheFallopiantubes(salpingo-oophorectomy)anduterus(hysterectomy).[46]Cessationofmensesasaresultofremovaloftheovariesiscalled"surgicalmenopause".Surgicaltreatments,suchastheremovalofovaries,mightcauseperiodstostopaltogether.[33]Thesuddenandcompletedropinhormonelevelsusuallyproducesextremewithdrawalsymptomssuchashotflashes,etc.Thesymptomsofearlymenopausemaybemoresevere.[33] Removaloftheuteruswithoutremovaloftheovariesdoesnotdirectlycausemenopause,althoughpelvicsurgeryofthistypecanoftenprecipitateasomewhatearliermenopause,perhapsbecauseofacompromisedbloodsupplytotheovaries.[medicalcitationneeded]Thetimebetweensurgeryandpossibleearlymenopauseisduetothefactthatovariesarestillproducinghormones.[33] Mechanism[edit] Bonelossduetomenopauseoccursduetochangesinawoman'shormonelevels. Themenopausaltransition,andpostmenopauseitself,isanaturalchange,notusuallyadiseasestateoradisorder.Themaincauseofthistransitionisthenaturaldepletionandagingofthefiniteamountofoocytes(ovarianreserve).Thisprocessissometimesacceleratedbyotherconditionsandisknowntooccurearlierafterawiderangeofgynecologicproceduressuchashysterectomy(withandwithoutovariectomy),endometrialablationanduterinearteryembolisation.Thedepletionoftheovarianreservecausesanincreaseincirculatingfollicle-stimulatinghormone(FSH)andluteinizinghormone(LH)levelsbecausetherearefeweroocytesandfolliclesrespondingtothesehormonesandproducingestrogen. Thetransitionhasavariabledegreeofeffects.[47] Thestagesofthemenopausetransitionhavebeenclassifiedaccordingtoawoman'sreportedbleedingpattern,supportedbychangesinthepituitaryfollicle-stimulatinghormone(FSH)levels.[48] Inyoungerwomen,duringanormalmenstrualcycletheovariesproduceestradiol,testosteroneandprogesteroneinacyclicalpatternunderthecontrolofFSHandluteinizinghormone(LH),whicharebothproducedbythepituitarygland.Duringperimenopause(approachingmenopause),estradiollevelsandpatternsofproductionremainrelativelyunchangedormayincreasecomparedtoyoungwomen,butthecyclesbecomefrequentlyshorterorirregular.[49]TheoftenobservedincreaseinestrogenispresumedtobeinresponsetoelevatedFSHlevelsthat,inturn,ishypothesizedtobecausedbydecreasedfeedbackbyinhibin.[50]Similarly,decreasedinhibinfeedbackafterhysterectomyishypothesizedtocontributetoincreasedovarianstimulationandearliermenopause.[51][52] Themenopausaltransitionischaracterizedbymarked,andoftendramatic,variationsinFSHandestradiollevels.Becauseofthis,measurementsofthesehormonesarenotconsideredtobereliableguidestoawoman'sexactmenopausalstatus.[50] Menopauseoccursbecauseofthesharpdecreaseofestradiolandprogesteroneproductionbytheovaries.Aftermenopause,estrogencontinuestobeproducedmostlybyaromataseinfattissuesandisproducedinsmallamountsinmanyothertissuessuchasovaries,bone,bloodvessels,andthebrainwhereitactslocally.[53]Thesubstantialfallincirculatingestradiollevelsatmenopauseimpactsmanytissues,frombraintoskin. Incontrasttothesuddenfallinestradiolduringmenopause,thelevelsoftotalandfreetestosterone,aswellasdehydroepiandrosteronesulfate(DHEAS)andandrostenedioneappeartodeclinemoreorlesssteadilywithage.Aneffectofnaturalmenopauseoncirculatingandrogenlevelshasnotbeenobserved.[54]Thusspecifictissueeffectsofnaturalmenopausecannotbeattributedtolossofandrogenichormoneproduction.[55] Hotflashesandothervasomotorsymptomsaccompanythemenopausaltransition.Whilemanysourcescontinuetoclaimthathotflashesduringthemenopausaltransitionarecausedbylowestrogenlevels,thisassertionwasshownincorrectin1935,and,inmostcases,hotflashesareobserveddespiteelevatedestrogenlevels.Theexactcauseofthesesymptomsisnotyetunderstood,possiblefactorsconsideredarehigheranderraticvariationofestradiollevelduringthecycle,elevatedFSHlevelswhichmayindicatehypothalamicdysregulationperhapscausedbymissingfeedbackbyinhibin.Ithasbeenalsoobservedthatthevasomotorsymptomsdifferduringearlyperimenopauseandlatemenopausaltransitionanditispossiblethattheyarecausedbyadifferentmechanism.[49] Long-termeffectsofmenopausemayincludeosteoporosis,vaginalatrophyaswellaschangedmetabolicprofileresultingincardiacrisks. Ovarianaging[edit] Decreasedinhibinfeedbackafterhysterectomyishypothesizedtocontributetoincreasedovarianstimulationandearliermenopause.Hastenedovarianaginghasbeenobservedafterendometrialablation.Whileitisdifficulttoprovethatthesesurgeriesarecausative,ithasbeenhypothesizedthattheendometriummaybeproducingendocrinefactorscontributingtotheendocrinefeedbackandregulationoftheovarianstimulation.Eliminationofthesefactorscontributestofasterdepletionoftheovarianreserve.Reducedbloodsupplytotheovariesthatmayoccurasaconsequenceofhysterectomyanduterinearteryembolisationhasbeenhypothesizedtocontributetothiseffect.[51][52] ImpairedDNArepairmechanismsmaycontributetoearlierdepletionoftheovarianreserveduringaging.[56]Aswomenage,double-strandbreaksaccumulateintheDNAoftheirprimordialfollicles.Primordialfolliclesareimmatureprimaryoocytessurroundedbyasinglelayerofgranulosacells.AnenzymesystemispresentinoocytesthatordinarilyaccuratelyrepairsDNAdouble-strandbreaks.Thisrepairsystemiscalled"homologousrecombinationalrepair",anditisespeciallyeffectiveduringmeiosis.Meiosisisthegeneralprocessbywhichgermcellsareformedinallsexualeukaryotes;itappearstobeanadaptationforefficientlyremovingdamagesingermlineDNA.[57] Humanprimaryoocytesarepresentatanintermediatestageofmeiosis,termedprophaseI(seeOogenesis).ExpressionoffourkeyDNArepairgenesthatarenecessaryforhomologousrecombinationalrepairduringmeiosis(BRCA1,MRE11,Rad51,andATM)declinewithageinoocytes.[56]Thisage-relateddeclineinabilitytorepairDNAdouble-stranddamagescanaccountfortheaccumulationofthesedamages,thatthenlikelycontributestothedepletionoftheovarianreserve. Diagnosis[edit] Waysofassessingtheimpactonwomenofsomeofthesemenopauseeffects,includetheGreeneclimactericscalequestionnaire,[58]theCervantesscale[59]andtheMenopauseratingscale.[20] Premenopause[edit] Premenopauseisatermusedtomeantheyearsleadinguptothelastperiod,whenthelevelsofreproductivehormonesarebecomingmorevariableandlower,andtheeffectsofhormonewithdrawalarepresent.[46]Premenopausestartssometimebeforethemonthlycyclesbecomenoticeablyirregularintiming.[60] Perimenopause[edit] Theterm"perimenopause",whichliterallymeans"aroundthemenopause",referstothemenopausetransitionyearsbeforethedateofthefinalepisodeofflow.[1][11][61][62]AccordingtotheNorthAmericanMenopauseSociety,thistransitioncanlastforfourtoeightyears.[63]TheCentreforMenstrualCycleandOvulationResearchdescribesitasasix-toten-yearphaseending12monthsafterthelastmenstrualperiod.[64] Duringperimenopause,estrogenlevelsaverageabout20–30%higherthanduringpremenopause,oftenwithwidefluctuations.[64]Thesefluctuationscausemanyofthephysicalchangesduringperimenopauseaswellasmenopause,especiallyduringthelast1–2yearsofperimenopause(beforemenopause).[61][65]Someofthesechangesarehotflashes,nightsweats,difficultysleeping,moodswings,vaginaldrynessoratrophy,incontinence,osteoporosis,andheartdisease.[64]Perimenopauseisalsoassociatedwithahigherlikelihoodofdepression(affectingfrom45percentto68percentofperimenopausalwomen),whichistwiceaslikelytoaffectthosewithahistoryofdepression.[66] Duringthisperiod,fertilitydiminishesbutisnotconsideredtoreachzerountiltheofficialdateofmenopause.Theofficialdateisdeterminedretroactively,once12monthshavepassedafterthelastappearanceofmenstrualblood. Themenopausetransitiontypicallybeginsbetween40and50yearsofage(average47.5).[67][68]Thedurationofperimenopausemaybeforuptoeightyears.[68]Womenwilloften,butnotalways,startthesetransitions(perimenopauseandmenopause)aboutthesametimeastheirmotherdid.[69] Insomewomen,menopausemaybringaboutasenseoflossrelatedtotheendoffertility.Inaddition,thischangeoftenoccurswhenotherstressorsmaybepresentinawoman'slife: Caringfor,and/orthedeathof,elderlyparents Emptynestsyndromewhenchildrenleavehome Thebirthofgrandchildren,whichplacespeopleof"middleage"intoanewcategoryof"olderpeople"(especiallyincultureswherebeingolderisastatethatislookeddownon) Someresearchappearstoshowthatmelatoninsupplementationinperimenopausalwomencanimprovethyroidfunctionandgonadotropinlevels,aswellasrestoringfertilityandmenstruationandpreventingdepressionassociatedwithmenopause.[70] Postmenopause[edit] Theterm"postmenopausal"describeswomenwhohavenotexperiencedanymenstrualflowforaminimumof12months,assumingthattheyhaveauterusandarenotpregnantorlactating.[46]Inwomenwithoutauterus,menopauseorpostmenopausecanbeidentifiedbyabloodtestshowingaveryhighFSHlevel.Thuspostmenopauseisthetimeinawoman'slifethattakesplaceafterherlastperiodor,moreaccurately,afterthepointwhenherovariesbecomeinactive. Thereasonforthisdelayindeclaringpostmenopauseisthatperiodsareusuallyerraticatthistimeoflife.Therefore,areasonablylongstretchoftimeisnecessarytobesurethatthecyclinghasceased.Atthispointawomanisconsideredinfertile;however,thepossibilityofbecomingpregnanthasusuallybeenverylow(butnotquitezero)foranumberofyearsbeforethispointisreached. Awoman'sreproductivehormonelevelscontinuetodropandfluctuateforsometimeintopost-menopause,sohormonewithdrawaleffectssuchashotflashesmaytakeseveralyearstodisappear. Aperiod-likeflowduringpostmenopause,evenspotting,maybeasignofendometrialcancer. Management[edit] Perimenopauseisanaturalstageoflife.Itisnotadiseaseoradisorder.Therefore,itdoesnotautomaticallyrequireanykindofmedicaltreatment.However,inthosecaseswherethephysical,mental,andemotionaleffectsofperimenopausearestrongenoughthattheysignificantlydisruptthelifeofthewomanexperiencingthem,palliativemedicaltherapymaysometimesbeappropriate. Hormonereplacementtherapy[edit] Mainarticle:Hormonereplacementtherapy(menopause) Inthecontextofthemenopause,hormonereplacementtherapy(HRT)istheuseofestrogeninwomenwithoutauterusandestrogenplusprogestininwomenwhohaveanintactuterus.[71] HRTmaybereasonableforthetreatmentofmenopausalsymptoms,suchashotflashes.[72]Itisthemosteffectivetreatmentoption,especiallywhendeliveredasaskinpatch.[73][74]Itsuse,however,appearstoincreasetheriskofstrokesandbloodclots.[75]Whenusedformenopausalsymptomssomerecommenditbeusedfortheshortesttimepossibleandatthelowestdosepossible.[75]Evidencetosupportlong-termuse,however,ispoor.[73] Italsoappearseffectiveforpreventingbonelossandosteoporoticfracture,[76]butitisgenerallyrecommendedonlyforwomenatsignificantriskforwhomothertherapiesareunsuitable.[77] HRTmaybeunsuitableforsomewomen,includingthoseatincreasedriskofcardiovasculardisease,increasedriskofthromboembolicdisease(suchasthosewithobesityorahistoryofvenousthrombosis)orincreasedriskofsometypesofcancer.[77]Thereissomeconcernthatthistreatmentincreasestheriskofbreastcancer.[78] Addingtestosteronetohormonetherapyhasapositiveeffectonsexualfunctioninpostmenopausalwomen,althoughitmaybeaccompaniedbyhairgrowth,acneandareductioninhigh-densitylipoprotein(HDL)cholesterol.[79]Thesesideeffectsdivergedependingonthedosesandmethodsofusingtestosterone.[79] Selectiveestrogenreceptormodulators[edit] SERMsareacategoryofdrugs,eithersyntheticallyproducedorderivedfromabotanicalsource,thatactselectivelyasagonistsorantagonistsontheestrogenreceptorsthroughoutthebody.ThemostcommonlyprescribedSERMsareraloxifeneandtamoxifen.Raloxifeneexhibitsoestrogenagonistactivityonboneandlipids,andantagonistactivityonbreastandtheendometrium.[80]Tamoxifenisinwidespreadusefortreatmentofhormonesensitivebreastcancer.Raloxifenepreventsvertebralfracturesinpostmenopausal,osteoporoticwomenandreducestheriskofinvasivebreastcancer.[81] Othermedications[edit] SomeoftheSSRIsandSNRIsappeartoprovidesomerelieffromvasomotorsymptoms.[5]Lowdoseparoxetineistheonlynon-hormonalmedicationthatwasFDA-approvedtotreatmoderate-to-severevasomotorsymptomsassociatedwithmenopauseasof2016.[82][83]Theymay,however,beassociatedwithappetiteandsleepingproblems,constipationandnausea.[5][84] Gabapentinorclonidinemayhelpbutdonotworkaswellashormonetherapy.[5]Gabapentincandecreasetheamountofhotflashes.Sideeffectsassociatedwithitsuseincludedrowsinessandheadaches.Clonidineisusedtoimprovevasomotorsymptomsandmaybeassociatedwithconstipation,dizziness,nauseaandsleepingproblems.[5][84] Therapy[edit] Onereviewfoundmindfulnessandcognitivebehaviouraltherapydecreasestheamountwomenareaffectedbyhotflashes.[85]Anotherreviewfoundnotenoughevidencetomakeaconclusion.[86]A2018studyfoundthat85%ofstudyparticipantsreportedreducedhotflashesandnightsweatswhenusingaclimatecontrolsystemintheirbeds.[87] Exercise[edit] Exercisehasbeenthoughttoreducepostmenopausalsymptomsthroughtheincreaseofendorphinlevels,whichdecreaseasestrogenproductiondecreases.[88]Additionally,highBMIisariskfactorforvasomotorsymptomsinparticular.However,thereisinsufficientevidencetosupportthebenefitsofweightlossforsymptommanagement.[89]Therearemixedperspectivesonthebenefitsofphysicalexercise.Whileonereviewfoundthattherewasalackofqualityevidencesupportingabenefitofexercise,[88]anotherreviewrecommendedregularhealthyexercisetoreducecomorbidities,improvemoodandanxietysymptoms,enhancecognition,anddecreasetheriskoffractures.[90]Yogamayhelpwithpostmenopausalsymptomssimilartootherexercise.[91]Thereisinsufficientevidencetosuggestthatrelaxationtechniquesreducemenopausalsymptoms.[92] Alternativemedicine[edit] Thereisnoevidenceofconsistentbenefitofalternativetherapiesformenopausalsymptomsdespitetheirpopularity.[93] Theeffectofsoyisoflavonesonmenopausalsymptomsispromisingforreductionofhotflashesandvaginaldryness.[15][94]Evidencedoesnotsupportabenefitfromphytoestrogenssuchascoumestrol,[95]femarelle,[96]orthenon-phytoestrogenblackcohosh.[15][97]Asof2011thereisnosupportforherbalordietarysupplementsinthepreventionortreatmentofthementalchangesthatoccuraroundmenopause.[98] Hypnosismayreducetheseverityofhotflashes.Inaddition,relaxationtrainingwithat-homerelaxationaudiotapessuchasdeepbreathing,pacedrespiration,andguidedimagerymayhavepositiveeffectsonrelaxingmusclesandreducingstress.[99] Thereisnoevidencetosupporttheefficacyofacupunctureasamanagementformenopausalsymptoms.[100][93]A2016CochranereviewfoundnotenoughevidencetoshowadifferencebetweenChineseherbalmedicineandplaceboforthevasomotorsymptoms.[101] Otherefforts[edit] Lackoflubricationisacommonproblemduringandafterperimenopause.Vaginalmoisturizerscanhelpwomenwithoveralldryness,andlubricantscanhelpwithlubricationdifficultiesthatmaybepresentduringintercourse.Itisworthpointingoutthatmoisturizersandlubricantsaredifferentproductsfordifferentissues:somewomencomplainthattheirgenitaliaareuncomfortablydryallthetime,andtheymaydobetterwithmoisturizers.Thosewhoneedonlylubricantsdowellusingthemonlyduringintercourse. Low-doseprescriptionvaginalestrogenproductssuchasestrogencreamsaregenerallyasafewaytouseestrogentopically,tohelpvaginalthinninganddrynessproblems(seevaginalatrophy)whileonlyminimallyincreasingthelevelsofestrogeninthebloodstream. Intermsofmanaginghotflashes,lifestylemeasuressuchasdrinkingcoldliquids,stayingincoolrooms,usingfans,removingexcessclothing,andavoidinghotflashtriggerssuchashotdrinks,spicyfoods,etc.,maypartiallysupplement(orevenobviate)theuseofmedicationsforsomewomen. Individualcounselingorsupportgroupscansometimesbehelpfultohandlesad,depressed,anxiousorconfusedfeelingswomenmaybehavingastheypassthroughwhatcanbeforsomeaverychallengingtransitiontime. Osteoporosiscanbeminimizedbysmokingcessation,adequatevitaminDintakeandregularweight-bearingexercise.Thebisphosphonatedrugalendronatemaydecreasetheriskofafracture,inwomenthathavebothbonelossandapreviousfractureandlesssoforthosewithjustosteoporosis.[102] Asurgicalprocedurewhereapartofoneoftheovariesisremovedearlierinlifeandfrozenandthenovertimethawedandreturnedtothebodyhasbeentried.Whileatleast11womenhaveundergonetheprocedureandpaidover£6,000,thereisnoevidenceitissafeoreffective.[103] Societyandculture[edit] Theculturalcontextwithinwhichawomanlivescanhaveasignificantimpactonthewaysheexperiencesthemenopausaltransition.Menopausehasbeendescribedasasubjectiveexperience,withsocialandculturalfactorsplayingaprominentroleinthewaymenopauseisexperiencedandperceived. ThewordmenopausewasinventedbyFrenchdoctorsatthebeginningofthenineteenthcentury.Someofthemnotedthatpeasantwomenhadnocomplaintsabouttheendofmenses,whileurbanmiddle-classwomenhadmanytroublingsymptoms.Doctorsatthistimeconsideredthesymptomstobetheresultofurbanlifestylesofsedentarybehaviour,alcoholconsumption,toomuchtimeindoors,andover-eating,withalackoffreshfruitandvegetables.[104] WithintheUnitedStates,sociallocationaffectsthewaywomenperceivemenopauseanditsrelatedbiologicaleffects.Researchindicatesthatwhetherawomanviewsmenopauseasamedicalissueoranexpectedlifechangeiscorrelatedwithhersocio-economicstatus.[105]Theparadigmwithinwhichawomanconsidersmenopauseinfluencesthewaysheviewsit:Womenwhounderstandmenopauseasamedicalconditionrateitsignificantlymorenegativelythanthosewhoviewitasalifetransitionorasymbolofaging.[106] Ethnicityandgeographyplayrolesintheexperienceofmenopause.Americanwomenofdifferentethnicitiesreportsignificantlydifferenttypesofmenopausaleffects.OnemajorstudyfoundCaucasianwomenmostlikelytoreportwhataresometimesdescribedaspsychosomaticsymptoms,whileAfrican-Americanwomenweremorelikelytoreportvasomotorsymptoms.[107] ItseemsthatJapanesewomenexperiencemenopauseeffects,orkonenki,inadifferentwayfromAmericanwomen.[108]Japanesewomenreportlowerratesofhotflashesandnightsweats;thiscanbeattributedtoavarietyoffactors,bothbiologicalandsocial.Historically,konenkiwasassociatedwithwealthymiddle-classhousewivesinJapan,i.e.,itwasa"luxurydisease"thatwomenfromtraditional,inter-generationalruralhouseholdsdidnotreport.MenopauseinJapanwasviewedasasymptomoftheinevitableprocessofaging,ratherthana"revolutionarytransition",ora"deficiencydisease"inneedofmanagement.[108] InJapaneseculture,reportingofvasomotorsymptomshasbeenontheincrease,withresearchconductedin2005findingthatof140Japaneseparticipants,hotflasheswereprevalentin22.1%.[109]Thiswasalmostdoublethatof20yearsprior.[110]Whilsttheexactcauseforthisisunknown,possiblecontributingfactorsincludesignificantdietarychanges,increasedmedicalisationofmiddle-agedwomenandincreasedmediaattentiononthesubject.[110]However,reportingofvasomotorsymptomsisstillsignificantlylowerthanNorthAmerica.[111] Additionally,whilemostwomenintheUnitedStatesapparentlyhaveanegativeviewofmenopauseasatimeofdeteriorationordecline,somestudiesseemtoindicatethatwomenfromsomeAsiancultureshaveanunderstandingofmenopausethatfocusesonasenseofliberationandcelebratesthefreedomfromtheriskofpregnancy.[112] Divergingfromtheseconclusions,onestudyappearedtoshowthatmanyAmericanwomen"experiencethistimeasoneofliberationandself-actualization".[113] Etymology[edit] Menopauseliterallymeansthe"endofmonthlycycles"(theendofmonthlyperiodsormenstruation),fromtheGreekwordpausis("pause")andmēn("month").Thisisamedicalcoinage;theGreekwordformensesisactuallydifferent.InAncientGreek,themensesweredescribedintheplural,taemmēnia,("themonthlies"),anditsmoderndescendanthasbeenclippedtotaemmēna.TheModernGreekmedicaltermisemmenopausisinKatharevousaoremmenopausiinDemoticGreek. Theword"menopause"wascoinedspecificallyforhumanfemales,wheretheendoffertilityistraditionallyindicatedbythepermanentstoppingofmonthlymenstruations.However,menopauseexistsinsomeotheranimals,manyofwhichdonothavemonthlymenstruation;[114]inthiscase,thetermmeansanaturalendtofertilitythatoccursbeforetheendofthenaturallifespan. Menopauseinpopularculture[edit] Inrecentyearscelebritieshavespokenoutabouttheirexperiencesofthemenopausewhichhasleadtoitbecominglessofatabooasithasboostedawarenessofthedebilitatingsymptoms. ThishasleadtoTVshowsrunningfeaturesonthemenopausetohelpwomenexperiencingsymptoms.IntheUKLorraineKellyhasbeenanadvocateforgettingwomentospeakabouttheirexperiencesincludingsharingherown.ThishasleadtoanincreaseinwomenseekingtreatmentsuchasHRT[115] Evolutionaryrationale[edit] Seealso:DisposablesomatheoryofagingandPatriarchhypothesis Fewanimalshaveamenopause:humansarejoinedbyjustfourotherspeciesinwhichfemaleslivesubstantiallylongerthantheirabilitytoreproduce.Theothersareallcetaceans:belugawhales,narwhals,orcasandshort-finnedpilotwhales.[116]Varioustheorieshavebeensuggestedthatattempttosuggestevolutionarybenefitstothehumanspeciesstemmingfromthecessationofwomen'sreproductivecapabilitybeforetheendoftheirnaturallifespan.Explanationscanbecategorizedasadaptiveandnon-adaptive: Non-adaptivehypotheses[edit] Thehighcostoffemaleinvestmentinoffspringmayleadtophysiologicaldeteriorationsthatamplifysusceptibilitytobecominginfertile.Thishypothesissuggeststhereproductivelifespaninhumanshasbeenoptimized,butithasprovenmoredifficultinfemalesandthustheirreproductivespanisshorter.Ifthishypothesisweretrue,however,ageatmenopauseshouldbenegativelycorrelatedwithreproductiveeffort,[117]andtheavailabledatadonotsupportthis.[118] Arecentincreaseinfemalelongevityduetoimprovementsinthestandardoflivingandsocialcarehasalsobeensuggested.[119]Itisdifficultforselection,however,tofavoraidtooffspringfromparentsandgrandparents.[120]Irrespectiveoflivingstandards,adaptiveresponsesarelimitedbyphysiologicalmechanisms.Inotherwords,senescenceisprogrammedandregulatedbyspecificgenes.[121] Earlyhumanselectionshadow[edit] Whileitisfairlycommonforextanthunter-gathererstolivepastage50providedthattheysurvivechildhood,fossilevidenceshowsthatmortalityinadultshasdecreasedoverthelast30,000to50,000yearsandthatitwasextremelyunusualforearlyHomosapienstolivetoage50.ThisdiscoveryhasledsomebiologiststoarguethattherewasnoselectionfororagainstmenopauseatthetimeatwhichtheancestorofallmodernhumanslivedinAfrica,suggestingthatmenopauseisinsteadarandomevolutionaryeffectofaselectionshadowregardingaginginearlyHomosapiens.Itisalsoarguedthatsincethepopulationfractionofpost-menopausalwomeninearlyHomosapienswassolow,menopausehadnoevolutionaryeffectonmateselectionorsocialbehaviorsrelatedtomateselection.[122][123] Adaptivehypotheses[edit] "Survivalofthefittest"hypothesis[edit] Thishypothesissuggeststhatyoungermothersandoffspringundertheircarewillfarebetterinadifficultandpredatoryenvironmentbecauseayoungermotherwillbestrongerandmoreagileinprovidingprotectionandsustenanceforherselfandanursingbaby.Thevariousbiologicalfactorsassociatedwithmenopausehadtheeffectofmalemembersofthespeciesinvestingtheireffortwiththemostviableofpotentialfemalemates.[124][page needed]Oneproblemwiththishypothesisisthatwewouldexpecttoseemenopauseexhibitedintheanimalkingdom,[114]andanotherproblemisthatinthecaseofextendedchilddevelopment,evenafemalewhowasrelativelyyoung,stillagile,andattractivewhenproducingachildwouldlosefuturesupportfromhermalepartnerduetohimseekingoutfertilemateswhenshereachesmenopausewhilethechildisstillnotindependent.Thatwouldbecounterproductivetothesupposedadaptationofgettingmalesupportasafertilefemaleandruinsurvivalforchildrenproducedovermuchofthefemale'sfertileandagilelife,unlesschildrenwereraisedinwaysthatdidnotrelyonsupportfromamalepartnerwhichwouldeliminatethattypeofresourcedivertingselectionanyway.[125][126] Youngfemalepreferencehypothesis[edit] Theyoungfemalepreferencehypothesisproposesthatchangesinmalepreferencesforyoungermatesallowedlate-ageactingfertilitymutationstoaccumulateinfemaleswithoutanyevolutionarypenalty,givingrisetomenopause.Acomputermodelwasconstructedtotestthishypothesis,andshowedthatitwasfeasible.[127]However,inorderfordeleteriousmutationsthataffectfertilitypastroughlyagefiftytoaccumulate,humanmaximumlifespanhadtofirstbeextendedtoaboutitspresentvalue.Asof2016itwasuncleariftherehasbeensufficienttimesincethathappenedforsuchanevolutionaryprocesstooccur.[128] Male-biasedphilopatryhypothesis[edit] Themale-biasedphilopatrytheoryproposesthatmale-biasedphilopatryinsocialspeciesleadstoincreasedrelatednesstothegroupinrelationtofemaleage,makinginclusivefitnessbenefitsolderfemalesreceivefromhelpingthegroupgreaterthanwhattheywouldreceivefromcontinuedreproduction,whicheventuallyledtotheevolutionofmenopause.[129]Inapatternofmale-biaseddispersalandlocalmating,therelatednessoftheindividualsinthegroupdecreaseswithfemaleage,leadingtoadecreaseinkinselectionwithfemaleage.[129]Thisoccursbecauseafemalewillstaywithherfatherinhernatalgroupthroughoutlife,initiallybeingcloselyrelatedtothemalesandfemales.Femalesarebornandstayinthegroup,sorelatednesstothefemalesstaysaboutthesame.However,throughouttime,theoldermalerelativeswilldieandanysonsshegivesbirthtowilldisperse,sothatlocalrelatednesstomales,andthereforethewholegroup,declines.Thesituationisreversedinspecieswheremalesarephilopatricandeitherfemalesdisperse,ormatingisnon-local.[129]Undertheseconditions,afemale'sreproductivelifebeginsawayfromherfatherandpaternalrelativesbecauseshewaseitherbornintoanewgroupfromnon-localmatingorbecauseshedispersed.Inthecaseoffemale-biaseddispersal,thefemaleisinitiallyequallyunrelatedwitheveryindividualinthegroup,andwithnon-localmating,thefemaleiscloselyrelatedtothefemalesofthegroup,butnotthemalessinceherpaternalrelativesareinanothergroup.Asshegivesbirth,hersonswillstaywithher,increasingherrelatednesstomalesinthegroupovertimeandthusherrelatednesswiththeoverallgroup.Thecommonfeaturethatconnectsthesetwootherwisedifferentbehaviorsismale-biasedphilopatry,whichleadstoanincreaseinkinselectionwithfemaleage. Whilenotconclusive,evidencedoesexisttosupporttheideathatfemale-biaseddispersalexistedinpre-modernhumans.Theclosestlivingrelativestohumans,chimpanzees,bonobos,andbothmountaingorillasandwesternlowlandgorillas,arefemale-biaseddispersers.[130]Analysisofsexspecificgeneticmaterial,thenon-recombiningportionsoftheYchromosomeandmitochondrialDNA,showevidenceofaprevalenceoffemale-biaseddispersalaswell;however,theseresultscouldalsobeaffectedbytheeffectivebreedingnumbersofmalesandfemalesinlocalpopulations.[131]Evidenceoffemale-biaseddispersioninhunter-gatherersisnotdefinitive,withsomestudiessupportingtheidea,[130]andotherssuggestingthereisnostrongbiastowardseithersex.[132]Inorcas,bothsexesmatenon-locallywithmembersofadifferentpodbutreturntothepodaftercopulation.[133]Demographicdatashowsthatafemale'smeanrelatednesstothegroupdoesincreaseovertimeduetoincreasingrelatednesstomales.[134]Whilelesswell-studied,thereisevidencethatshort-finnedpilotwhales,anothermenopausalspecies,alsodisplaythisbehavior.[135]However,matingbehaviorthatincreaseslocalrelatednesswithfemaleageisprevalentinnon-menopausalspecies,[130]makingitunlikelythatitistheonlyfactorthatdeterminesifmenopausewillevolveinaspecies. Motherhypothesis[edit] Themotherhypothesissuggeststhatmenopausewasselectedforhumansbecauseoftheextendeddevelopmentperiodofhumanoffspringandhighcostsofreproductionsothatmothersgainanadvantageinreproductivefitnessbyredirectingtheireffortfromnewoffspringwithalowsurvivalchancetoexistingchildrenwithahighersurvivalchance.[136] Grandmotherhypothesis[edit] Thegrandmotherhypothesissuggeststhatmenopausewasselectedforhumansbecauseitpromotesthesurvivalofgrandchildren.Accordingtothishypothesis,post-reproductivewomenfeedandcareforchildren,adultnursingdaughters,andgrandchildrenwhosemothershaveweanedthem.Humanbabiesrequirelargeandsteadysuppliesofglucosetofeedthegrowingbrain.Ininfantsinthefirstyearoflife,thebrainconsumes60%ofallcalories,sobothbabiesandtheirmothersrequireadependablefoodsupply.Someevidencesuggeststhathunterscontributelessthanhalfthetotalfoodbudgetofmosthunter-gatherersocieties,andoftenmuchlessthanhalf,sothatforaginggrandmotherscancontributesubstantiallytothesurvivalofgrandchildrenattimeswhenmothersandfathersareunabletogatherenoughfoodforalloftheirchildren.Ingeneral,selectionoperatesmostpowerfullyduringtimesoffamineorotherprivation.Soalthoughgrandmothersmightnotbenecessaryduringgoodtimes,manygrandchildrencannotsurvivewithoutthemduringtimesoffamine. Post-reproductivefemaleorcastendtoleadtheirpods,especiallyduringyearsoffoodscarcity.[137]Furthermore,theincreasedmortalityriskofanorcaduetolosingagrandmotherisstrongerinyearsfoodscarcity[138] Analysisofhistoricaldatafoundthatthelengthofafemale'spost-reproductivelifespanwasreflectedinthereproductivesuccessofheroffspringandthesurvivalofhergrandchildren.[139]Anotherstudyfoundcomparativeeffectsbutonlyinthematernalgrandmother—paternalgrandmothershadadetrimentaleffectoninfantmortality(probablyduetopaternityuncertainty).[140]Differingassistancestrategiesformaternalandpaternalgrandmothershavealsobeendemonstrated.Maternalgrandmothersconcentrateonoffspringsurvival,whereaspaternalgrandmothersincreasebirthrates.[141] Somebelievevariationsonthemother,orgrandmothereffectfailtoexplainlongevitywithcontinuedspermatogenesisinmales(oldestverifiedpaternityis94years,35yearsbeyondtheoldestdocumentedbirthattributedtofemales).[142]Notably,thesurvivaltimepastmenopauseisroughlythesameasthematurationtimeforahumanchild.Thatamother'spresencecouldaidinthesurvivalofadevelopingchild,whileanunidentifiedfather'sabsencemightnothaveaffectedsurvival,couldexplainthepaternalfertilityneartheendofthefather'slifespan.[143]Amanwithnocertaintyofwhichchildrenarehismaymerelyattempttofatheradditionalchildren,withsupportofexistingchildrenpresentbutsmall.Notetheexistenceofpartiblepaternitysupportingthis.[144]Somearguethatthemotherandgrandmotherhypothesesfailtoexplainthedetrimentaleffectsoflosingovarianfollicularactivity,suchasosteoporosis,osteoarthritis,Alzheimer'sdiseaseandcoronaryarterydisease.[145] Thetheoriesdiscussedaboveassumethatevolutiondirectlyselectedformenopause.Anothertheorystatesthatmenopauseisthebyproductoftheevolutionaryselectionforfollicularatresia,afactorthatcausesmenopause.Menopauseresultsfromhavingtoofewovarianfolliclestoproduceenoughestrogentomaintaintheovarian-pituitary-hypothalamicloop,whichresultsinthecessationofmensesandthebeginningofmenopause.Humanfemalesarebornwithapproximatelyamillionoocytes,andapproximately400oocytesarelosttoovulationthroughoutlife.[146][147] Reproductiveconflicthypothesis[edit] Insocialvertebrates,thesharingofresourcesamongthegroupplaceslimitsonhowmanyoffspringcanbeproducedandsupportedbymembersofthegroup.Thiscreatesasituationinwhicheachfemalemustcompetewithothersofthegrouptoensuretheyaretheonethatreproduces.[148]Thereproductiveconflicthypothesisproposesthatthisfemalereproductiveconflictfavorsthecessationoffemalereproductivepotentialinolderagetoavoidreproductiveconflict,increasingtheolderfemale'sfitnessthroughinclusivebenefits.Female-biaseddispersalornon-localmatingleadstoanincreaseinrelatednesstothesocialgroupwithfemaleage.[129]Inthehumancaseoffemale-biaseddispersal,whenayoungfemaleentersanewgroup,sheisnotrelatedtoanyindividualandshereproducestoproduceanoffspringwitharelatednessof0.5.Anolderfemalecouldalsochoosetoreproduce,producinganoffspringwitharelatednessof0.5,orshecouldrefrainfromreproducingandallowanotherpairtoreproduce.Becauseherrelatednesstomalesinthegroupishigh,thereisafairprobabilitythattheoffspringwillbehergrandchildwitharelatednessof0.25.Theyoungerfemaleexperiencesnocosttoherinclusivefitnessfromusingtheresourcesnecessarytosuccessfullyrearoffspringsincesheisnotrelatedtomembersofthegroup,butthereisacostfortheolderfemale.Asaresult,theyoungerfemalehastheadvantageinreproductivecompetition.Althoughafemaleorcabornintoasocialgroupisrelatedtosomemembersofthegroup,thewhalecaseofnon-localmatingleadstosimilaroutcomesbecausetheyoungerfemalerelatednesstothegroupasawholeislessthantherelatednessoftheolderfemale.Thisbehaviormakesmorelikelythecessationofreproductionlateinlifetoavoidreproductiveconflictwithyoungerfemales. Researchusingbothhumanandorcademographicdatahasbeenpublishedthatsupportstheroleofreproductiveconflictintheevolutionofmenopause.Analysisofdemographicdatafrompre-industrialFinnishpopulationsfoundsignificantreductionsinoffspringsurvivorshipwhenmothers-in-lawsanddaughters-in-lawshadoverlappingbirths,[149]supportingtheideathatavoidingreproductiveconflictisbeneficialtooffspringsurvivorship.Humans,moresothanotherprimates,relyonfoodsharingforsurvival,[150]sothelargesurvivorshipreductionvaluescouldbecausedbyastrainingofcommunityresources.Avoidingsuchstrainingisapossibleexplanationforwhythereproductiveoverlapseeninhumansismuchlowerthanotherprimates.[151]Foodsharingisalsoprevalentamonganothermenopausalspecies,orcas.[152]Reproductiveconflicthasalsobeenobservedinorcas,withincreasedcalfmortalityseenwhenreproductiveoverlapbetweenayoungerandoldergenerationalfemaleoccurred.[134] Otheranimals[edit] Menopauseintheanimalkingdomappearstobeuncommon,butthepresenceofthisphenomenonindifferentspecieshasnotbeenthoroughlyresearched.Lifehistoriesshowavaryingdegreeofsenescence;rapidsenescingorganisms(e.g.,Pacificsalmonandannualplants)donothaveapost-reproductivelife-stage.Gradualsenescenceisexhibitedbyallplacentalmammalianlifehistories. Menopausehasbeenobservedinseveralspeciesofnonhumanprimates,[114]includingrhesusmonkeys[153]andchimpanzees.[154]Someresearchsuggeststhatwildchimpanzeesdonotexperiencemenopause,astheirfertilitydeclinesareassociatedwithdeclinesinoverallhealth.[155]Menopausealsohasbeenreportedinavarietyofothervertebratespeciesincludingelephants,[156]short-finnedpilotwhales,[157]orcas,[158]narwhals,[159]belugawhales,[159]andtheguppy.[160]However,withtheexceptionoftheshort-finnedpilotwhale,killerwhale,narwhals,andbelugawhales,[159]suchexamplestendtobefromcaptiveindividuals,andthustheyarenotnecessarilyrepresentativeofwhathappensinnaturalpopulationsinthewild. Dogsdonotexperiencemenopause;thecanineestruscyclesimplybecomesirregularandinfrequent.Althougholderfemaledogsarenotconsideredgoodcandidatesforbreeding,offspringhavebeenproducedbyolderanimals.[161]Similarobservationshavebeenmadeincats.[162] Seealso[edit] EuropeanMenopauseandAndropauseSociety Menopauseintheworkplace Menopauseinincarceration Pregnancyoverage50 References[edit] ^abcde"Menopause:Overview".EuniceKennedyShriverNationalInstituteofChildHealthandHumanDevelopment.28June2013.Archivedfromtheoriginalon2April2015.Retrieved8March2015. ^abcd"Whatismenopause?".EuniceKennedyShriverNationalInstituteofChildHealthandHumanDevelopment.28June2013.Archivedfromtheoriginalon19March2015.Retrieved8March2015. ^ab"Whatcausesmenopause?".EuniceKennedyShriverNationalInstituteofChildHealthandHumanDevelopment.6May2013.Archivedfromtheoriginalon2April2015.Retrieved8March2015. 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