The Menopause Transition: Physiology, Definition, Symptoms, Diagnosis, and Evaluation

The menopause transition is a gradual physiologic process characterized by an intricate interplay between hypothalamic-pituitary axis dysfunction and ovarian follicle failure. Clinically, symptoms are variable and can range from minimal to severe. The hallmark symptom of the perimenopause and postmenopause is the hot flash; however, systemically low estrogen has widespread effects in the aging woman, including important changes in the cardiovascular, musculoskeletal, genitourinary, and central nervous systems. The diagnosis of menopause is a clinical one. Although there is no single laboratory marker that can predict the final menstrual period, an elevated follicle stimulating hormone is the classic marker of a menopausal state. Newer evidence suggests that antimullerian hormone may be more predictive of the final menstrual period; however, more studies are needed. An understanding of the physiology and symptomatology of the menopausal transition is crucial for educating women about their health risks later in life. This review contains 2 figures and 30 references Key Words: hot flashes, menopause, perimenopause, postmenopause, race/ethnicity in menopause, stages of transition in menopause, stress/psychological complications, women’s health