Open in a separate window First-line treatment of a major depressive episode may involve psychotherapy, antidepressants, or a combination thereof. Treatment is often tailored to patient preference and severity of depression. Certainly, a more severe episode would require combined psychotherapy and pharmacotherapy. A mild to moderate episode may respond to either psychotherapy or an antidepressant alone, and if a patient is interested in a trial of medication, it may benefit significantly if this is started soon after the diagnosis is made.
Long-term effects[ edit ] Menopause confers: A possible but contentious increased risk of atherosclerosis. Induced menopause occurs as a result of medical treatment such as chemotherapyradiotherapyoophorectomyor complications of tubal ligationhysterectomyunilateral salpingo-oophorectomy or leuprorelin usage.
The average age of the last period in the United States is 51 years, in the United Kingdom is 52 years, in Ireland is 50 years and in Australia is 51 years. In India and the Philippinesthe median age of natural menopause is considerably earlier, at 44 years.
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. Other factors that can promote an earlier onset of menopause usually 1 to 3 years early are smoking cigarettes or being extremely thin.
The functional disorders often significantly speed up the menopausal process. An early menopause can be related to cigarette smoking, higher body mass indexracial and ethnic factors, illnesses, and the surgical removal of the ovarieswith or without the removal of the uterus.
The reasons for this are not completely understood. Transplants of ovarian tissue between identical twins have been successful in restoring fertility.
Surgical menopause[ edit ] Menopause can be surgically induced by bilateral oophorectomy removal of ovarieswhich is often, but not always, done in conjunction with removal of the Fallopian tubes salpingo-oophorectomy and uterus hysterectomy.
Surgical treatments, such as the removal of ovaries, might cause periods to stop altogether. The symptoms of early menopause may be more severe. The time between surgery and possible early menopause is due to the fact that ovaries are still producing hormones.
The menopausal transition, and postmenopause itself, is a natural change, not usually a disease state or a disorder. The main cause of this transition is the natural depletion and aging of the finite amount of oocytes ovarian reserve.
This process is sometimes accelerated by other conditions and is known to occur earlier after a wide range of gynecologic procedures such as hysterectomy with and without ovariectomyendometrial ablation and uterine artery embolisation.
The depletion of the ovarian reserve causes an increase in circulating follicle-stimulating hormone FSH and luteinizing hormone LH levels because there are fewer oocytes and follicles responding to these hormones and producing estrogen.
The transition has a variable degree of effects. During perimenopause approaching menopauseestradiol levels and patterns of production remain relatively unchanged or may increase compared to young women, but the cycles become frequently shorter or irregular.
Because of this, measurements of these hormones are not considered to be reliable guides to a woman's exact menopausal status. After menopause, estrogen continues to be produced mostly by aromatase in fat tissues and is produced in small amounts in many other tissues such as ovaries, bone, blood vessels, and the brain where it acts locally.
In contrast to the sudden fall in estradiol during menopause, the levels of total and free testosterone, as well as dehydroepiandrosterone sulfate DHEAS and androstenedione appear to decline more or less steadily with age. An effect of natural menopause on circulating androgen levels has not been observed.
While many sources continue to claim that hot flashes during the menopausal transition are caused by low estrogen levels, this assertion was shown incorrect in and, in most cases, hot flashes are observed despite elevated estrogen levels.
The exact cause of these symptoms is not yet understood, possible factors considered are higher and erratic variation of estradiol level during the cycle, elevated FSH levels which may indicate hypothalamic dysregulation perhaps caused by missing feedback by inhibin.
It has been also observed that the vasomotor symptoms differ during early perimenopause and late menopausal transition and it is possible that they are caused by a different mechanism.
Ovarian aging[ edit ] Decreased inhibin feedback after hysterectomy is hypothesized to contribute to increased ovarian stimulation and earlier menopause. 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. 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. 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.Exclusions included studies of women not undergoing the menopausal transition and experiencing menopause related symptoms, studies of aging and its effects, and biologically based studies that did not report epidemiological data relating to symptoms (e.g., studies of hormone levels).
A research review concluded that there’s not enough evidence to support its use for menopause symptoms.
Black cohosh generally has only mild side effects, if any. However, rare cases of liver damage—some of them very serious—have been reported in people taking commercial black cohosh products.
It's just your brain-- on menopause! A time when everything can seem topsy-turvey, when you cry at the drop of a hat, when every single molehill looks like a mountain, and, yes, a time when even a.
Eating soy protein or taking concentrated soy isoflavone extract seems to help hot flashes caused by menopause in some people.
Meta-analysis of the effects of soy protein intake on serum. Abstract. Premature menopause is a serious long-term side effect of chemotherapy.
We evaluated long-term pregnancy and disease-related outcomes for patients in S/POEMS, a study in premenopausal women with stage I–IIIA estrogen receptor–negative, progesterone receptor–negative breast cancer to be treated with cyclophosphamide-containing chemotherapy. Menopause Janjoosten Content.
to be phytoestrogens, plant chemicals that mimic the hormone estrogen. She was in intense pain from the surgery and, like many placenta accreta. of the female reproductive canal located between the uterus and the plombier-nemours.comted by the rotation of cilia that are tilted toward the posterior on cells of.