Editing Menopause (section)

== Causes ==
Menopause is a normal event in a woman's life and a natural part of aging.<ref name=":4" /> Menopause can also be induced early.<ref name=":12">{{Cite web |title=Early or premature menopause {{!}} Office on Women's Health |url=https://www.womenshealth.gov/menopause/early-or-premature-menopause |access-date=2022-10-21 |website=www.womenshealth.gov}}</ref> Induced menopause occurs as a result of medical treatment such as [[chemotherapy]], [[radiotherapy]], [[oophorectomy]], or complications of [[tubal ligation]], [[hysterectomy]], unilateral or bilateral salpingo-oophorectomy or [[leuprorelin]] usage.<ref>{{cite web |title=Gynaecologic Problems: Menopausal Problems |url=http://www.hon.ch/Dossier/MotherChild/gynae_problems/menopausal.html |url-status=dead |archive-url=https://web.archive.org/web/20210225095037/https://www.hon.ch/Dossier/MotherChild/gynae_problems/menopausal.html |archive-date=25 February 2021 |access-date=22 February 2012 |publisher=Health on the Net Foundation}}</ref>

=== Age ===
Menopause typically occurs at some point between 47 and 54 years of age.<ref name="Tak2015" /> According to various data, more than 95% of women have their last period between the ages of 44–56 (median 49–50).  2% of women under the age of 40, 5% between the ages of 40–45 and the same number between the ages of 55–58 have their last bleeding.<ref>{{cite journal |vauthors=Morabia A, Costanza MC |date=December 1998 |title=International variability in ages at menarche, first livebirth, and menopause. World Health Organization Collaborative Study of Neoplasia and Steroid Contraceptives |journal=American Journal of Epidemiology |volume=148 |issue=12 |pages=1195–205 |doi=10.1093/oxfordjournals.aje.a009609 |pmid=9867266 |doi-access=free}}</ref> The average age of the last period in the United States is 51 years, in Russia is 50 years, in Greece is 49 years, in Turkey is 47 years, in Egypt is 47 years and in India is 46 years.<ref>{{cite journal |vauthors=Ringa V |year=2000 |title=Menopause and treatments |journal=Quality of Life Research |volume=9 |issue=6 |pages=695–707 |doi=10.1023/A:1008913605129 |jstor=4036942 |s2cid=22496307}}</ref> Beyond the influence of genetics, these differences are also due to early-life environmental conditions<ref>{{Cite journal |last1=Begum |first1=Khurshida |last2=Muttukrishna |first2=Shanthi |last3=Sievert |first3=Lynnette Leidy |last4=Sharmeen |first4=Taniya |last5=Murphy |first5=Lorna |last6=Chowdhury |first6=Osul |last7=Kasim |first7=Adetayo |last8=Gunu |first8=Richard |last9=Bentley |first9=Gillian R. |date=March 2016 |title=Ethnicity or environment: effects of migration on ovarian reserve among Bangladeshi women in the United Kingdom |url=https://linkinghub.elsevier.com/retrieve/pii/S0015028215021081 |journal=Fertility and Sterility |language=en |volume=105 |issue=3 |pages=744–754.e1 |doi=10.1016/j.fertnstert.2015.11.024|pmid=26706133 }}</ref> and associated with epigenetic effects.<ref>{{Cite journal |last1=Bar-Sadeh |first1=Ben |last2=Rudnizky |first2=Sergei |last3=Pnueli |first3=Lilach |last4=Bentley |first4=Gillian R. |last5=Stöger |first5=Reinhard |last6=Kaplan |first6=Ariel |last7=Melamed |first7=Philippa |date=2020-09-15 |title=Unravelling the role of epigenetics in reproductive adaptations to early-life environment |url=https://www.nature.com/articles/s41574-020-0370-8 |journal=Nature Reviews Endocrinology |language=en |volume=16 |issue=9 |pages=519–533 |doi=10.1038/s41574-020-0370-8 |issn=1759-5029}}</ref> The menopausal transition or perimenopause leading up to menopause usually lasts 3–4 years (sometimes as long as 5–14 years).<ref name="NIH2013-Basics" /><ref name="NIA2017" />

Undiagnosed and untreated [[coeliac disease]] is a risk factor for early menopause. Coeliac disease can present with several non-gastrointestinal symptoms, in the absence of gastrointestinal symptoms, and most cases escape timely recognition and go undiagnosed, leading to a risk of long-term complications. A strict [[gluten-free diet]] reduces the risk. Women with early diagnosis and treatment of coeliac disease present a normal duration of fertile life span.<ref name="TersigniCastellani2">{{cite journal |vauthors=Tersigni C, Castellani R, de Waure C, Fattorossi A, De Spirito M, Gasbarrini A, Scambia G, Di Simone N |year=2014 |title=Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms |journal=Human Reproduction Update |volume=20 |issue=4 |pages=582–93 |doi=10.1093/humupd/dmu007 |pmid=24619876 |doi-access=free|hdl=10807/56796 |hdl-access=free }}</ref><ref name="LasaZubiaurre2">{{cite journal |vauthors=Lasa JS, Zubiaurre I, Soifer LO |year=2014 |title=Risk of infertility in patients with celiac disease: a meta-analysis of observational studies |journal=Arquivos de Gastroenterologia |volume=51 |issue=2 |pages=144–50 |doi=10.1590/S0004-28032014000200014 |pmid=25003268 |doi-access=free}}</ref>

Women who have undergone [[hysterectomy]] with ovary conservation go through menopause on average 1.5 years earlier than the expected age.<ref name="auto2" />

=== Premature ovarian insufficiency ===
In rare cases, a woman's ovaries stop working at a very early age, ranging anywhere from the age of [[puberty]] to age 40. This is known as [[premature ovarian failure]] or premature ovarian insufficiency (POI) and affects 1 to 2% of women by age 40.<ref>{{cite journal |vauthors=Podfigurna-Stopa A, Czyzyk A, Grymowicz M, Smolarczyk R, Katulski K, Czajkowski K, Meczekalski B |date=September 2016 |title=Premature ovarian insufficiency: the context of long-term effects |journal=[[Journal of Endocrinological Investigation]] |volume=39 |issue=9 |pages=983–90 |doi=10.1007/s40618-016-0467-z |pmc=4987394 |pmid=27091671}}</ref><ref name="Laissue20152">{{cite journal |vauthors=Laissue P |date=August 2015 |title=Aetiological coding sequence variants in non-syndromic premature ovarian failure: From genetic linkage analysis to next generation sequencing |journal=Molecular and Cellular Endocrinology |type=Review |volume=411 |pages=243–57 |doi=10.1016/j.mce.2015.05.005 |pmid=25960166 |doi-access=free}}</ref><ref name="-Fenton20152">{{cite journal |vauthors=Fenton AJ |year=2015 |title=Premature ovarian insufficiency: Pathogenesis and management |journal=Journal of Mid-Life Health |type=Review |volume=6 |issue=4 |pages=147–53 |doi=10.4103/0976-7800.172292 |pmc=4743275 |pmid=26903753 |doi-access=free }}</ref> It is diagnosed or confirmed by high blood levels of [[follicle stimulating hormone]] (FSH) and [[luteinizing hormone]] (LH) on at least three occasions at least four weeks apart.<ref name="Kalantaridou_10062">{{cite journal |vauthors=Kalantaridou SN, Davis SR, Nelson LM |date=December 1998 |title=Premature ovarian failure |journal=Endocrinology and Metabolism Clinics of North America |volume=27 |issue=4 |pages=989–1006 |doi=10.1016/s0889-8529(05)70051-7 |pmid=9922918}}</ref>

Premature ovarian insufficiency may be related to an auto immune disorder and therefore might co-occur with other [[autoimmune disorder]]s such as [[thyroid]] disease, [adrenal insufficiency], and [[diabetes mellitus]].<ref name="-Fenton20152" /> Other causes include [[chemotherapy]], being a carrier of the [[fragile X syndrome]] gene, and [[radiotherapy]].<ref name="-Fenton20152" /> However, in about 50–80% of cases of premature ovarian insufficiency, the cause is unknown, i.e., it is generally [[idiopathic]].<ref name="Laissue20152" /><ref name="Kalantaridou_10062" />

Early menopause can be related to [[cigarette]] smoking, higher [[body mass index]], racial and ethnic factors, illnesses, and the removal of the uterus.<ref name="Bucher, et al. 19302">Bucher, et al. 1930</ref>

=== Surgical menopause ===
Menopause can be surgically induced by bilateral [[oophorectomy]] (removal of ovaries),<ref name=":12" /> which is often, but not always, done in conjunction with removal of the fallopian tubes ([[salpingo-oophorectomy]]) and uterus ([[hysterectomy]]).<ref name="STRAW2">{{cite journal |vauthors=Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, Sherman S, Sluss PM, de Villiers TJ |date=April 2012 |title=Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging |journal=Fertility and Sterility |volume=97 |issue=4 |pages=843–51 |doi=10.1016/j.fertnstert.2012.01.128 |pmc=3340904 |pmid=22341880}}</ref> 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.<ref name="Womenshealth.gov2">{{Cite web |date=12 July 2017 |title=Early or premature menopause |url=https://www.womenshealth.gov/menopause/early-or-premature-menopause |access-date=7 November 2018 |work=Womenshealth.gov}}</ref> 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.<ref name="Womenshealth.gov2" />

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.{{medical citation needed|date=February 2015}} The time between surgery and possible early menopause is due to the fact that ovaries are still producing hormones.<ref name="Womenshealth.gov2" />