Menopause as Transition

Although the medical definition of menopause centers around a single event, it is impossible to identify this event until a woman has experienced 12 months of amenorrhea. Some women experience regular cycles until menopause, others may have irregular periods with heavy or scant bleeding. But regardless of the pattern, menopause itself is not a sudden event. Instead, it is a result of progressive hormonal changes that begin to take place several years before the actual cessation of menses.

It is important to recognize that education, counseling, and therapeutic intervention should not be limited to women who have experienced menopause. Postmenopausal women benefit greatly from such healthcare efforts. But it is critical to introduce these concepts and interventions early in a woman's menopausal transition. There is no reason to allow patients to suffer with immediate menopausal symptoms (ie, hot flushes and urogenital changes) for several months before beginning therapy.

In fact, early discussion of hormones as a therapeutic option in life might easily begin with women who use oral contraception. Women who realize that hormones, both estrogen and progesterone, have benefit for diverse reasons at different times during life may have a more useful frame of reference for considering HRT later in life.

Table 1