May 14, 2020
- Alternative Medicine related Interventions/Natural Remedies 11
- Emotional Support related Interventions 13
Menopause can be defined as the natural physiologic process experienced by every aging woman; yet, every woman can experience this transition stage in different ways. This is induced by a series of biological changes that can negatively and differentially impact women’s well-being and quality of life (Greenblum et al., 2013; Waidyasekera et al., 2009). The most common issues encompassed through the menopausal transition phase include mood swings, disturbed sleep patterns, sexual dysfunction, vaginal dryness, hot flashes, night sweats, chills, uterine bleeding problems, weight gain, decline in metabolism, dry skin and weak hair, and forgetfulness. Most of these can be attributed to the major hormonal deviations experienced during this transition. The most common issues reported among women are the hot flashes and night sweats (Polo-Kantola & Rantala, 2019; Greenblum et al., 2013; Waidyasekeraet al., 2009).
This phase is influenced by several factors including socio-cultural factors such as the prevalent values, beliefs and personal background of each woman. It is worth noting that this stage is also accompanied by personal challenges and role changes within the woman’s family and society. For example, negative social attitudes faced by women during menopause can affect the way in which they experience and manage menopausal issues. Similarly, a woman’s attitudes in managing her menopausal issues are influenced by the way in which menopause is experienced (Nosek et al., 2012; Ayers et al., 2010). Moreover, the menopausal condition and the issues accompanying it can vary across cultures (Avis and Crawford, 2008). For example, in western cultures specifically, menopause has been widely considered a phenomenon linked with negative consequences on women’s long-term health. This is mainly due to the limited availability of specialized literature which focuses on the quality of life during menopause (Mackey, 2004). Women from different races and ethnic groups are found to experience menopausal issues differently; and this is a result of a varying biological reaction to risk factors of menopausal issues – like alcohol- among different ethnic groups (Crawford, 2007; Miller et al., 2006).
When it comes to managing the menopausal issues arising during this stage, there is no specific way to deal with such challenges and changes due to the fact that they are directly influenced by each woman’s personal and socio-cultural background and beliefs (Hoga et al., 2015). Nowadays, the proper management of these issues has become a significant area of interest among researchers and public health practitioners due to the adverse effects they have on the woman’s general well-being and quality of life (Dalal & Agarwal, 2015). Personalized and context based support approaches, including personalized care and support, are needed for women who experience the menopause in different ways. This should also take into consideration women’s perceptions regarding menopause, as well as their different psychosocial and cultural backgrounds. This is vital in order to tailor the provided healthcare according to each woman’s needs, expectations and preferences, as this is the time where women feel the most vulnerable. For example, effective coping strategies and health interventions can be developed in several creative and dynamic ways which take into consideration the complexity of issues accompanying this stage (Hoga et al., 2015; Mori and Coelho, V. 2004). Moreover, comprehensive support, such as education on bodily and emotional changes, and approaches to self-care, through participative discussions, can be incorporated in health promotion activities. These activities can target the physical, psychosocial and cultural dimensions of menopause and can help in raising awareness and autonomy on attitudes towards the women’s own health (Ayers et al., 2010; De Lorenzi et al., 2009; Brazil, 2008).
In brief, findings from a systematic review that looked into 24 studies about women’s experience of menopause highlighted the six main points listed below (Hoga et al., 2015):
- Menopause is a natural life event associated with the changes of midlife and aging
- Menopause strongly affects women by inducing physical and emotional changes
- Menopause is mostly perceived as a time of gain and loss
- Resilience and coping strategies are needed at menopause to enhance physical and emotional wellbeing
- The sexual experience of women at menopause is affected by many factors such as health issues, personal relationships, social and cultural backgrounds and perceptions of women’s sex life
- Women at menopause should have their needs met and supported based on their perceptions
Eating healthy is a general advice that applies to everyone, women and men, of all ages. Women, at menopause and post-menopause stages yet, have to respect some particular aspects of their diet. These aspects are important as they help reducing the risk of heart issues and bone loss, while relieving the unpleasant effects associated with low levels of sex hormones.
Evidence form the literature shows that certain foods help soothing the effects of menopause issues, such as hot flashes and poor quality of sleep.
These foods are:
- Dairy products such as milk, yogurt and cheese
- Among a group of approximately 750 healthy postmenopausal women, a higher intake of proteins from animal sources and dairy products was associated with stronger bone and a lower risk of fractures (Durosier-Izart et al., 2017).
- In a study of nearly 11,000 postmenopausal women, those who suffered from shortened sleep were at a higher risk of having low bone mineral density (BMD) and developing osteoporosis (Ochs‐Balcom et al., 2020). Dairy foods, such as cheese, is shown to promote a deeper level of sleep, due to its richness in the amino acid glycine (Parazzini, 2015), thus decreasing the risks of bone fractures and osteoporosis among women at and after menopause.
- A high intake of Vitamin D and calcium, which cheese and fortified milk are rich in, was indicated to lower the risk of early menopause, according to one study (Purdue-Smithe, 2017).
- Healthy fats such as fatty fish (mackerel, salmon and anchovies), and seeds (flax seeds, chia seeds and hemp seeds)
- In a study that included around 900 postmenopausal women, those who ate oily fish regularly experienced a delayed onset of natural menopause (Dunneram et al., 2018).
- Regular consumption of flaxseed, rich in healthy fats, reduced the risk of heart diseases by lowering the LDL and total cholesterol levels, in a group of 55 postmenopausal women (Patade et al., 2017).
- Healthy fats are indicated to relieve the effects of hot flashes for menopausal women; yet, a recent review of 8 studies indicated that this statement is not conclusive (Ciappolino, 2018).
- Whole-grain foods such as brown rice, whole-wheat bread, barley, quinoa and rye
- Among a group of 11,040 postmenopausal women, those who consumed in a daily basis an average of 4.7 g whole grain fiber per 2,000 kcal had a 17% lower mortality rate, as compared to women who consumed predominantly refined grain fiber (Jacobs, 2000)
- Fruits and vegetables such as broccoli, berries
- In a group of 17,473 postmenopausal women, a healthy dietary modification that reduced fat intake and increased intake of fruit, vegetables, and whole grains, resulted in weight loss and less hot flashes (Kroenke et al., 2012).
- The consumption of cruciferous vegetables, such as cauliflower and broccoli, was proven to reduce the risk of breast cancer as indicated in a study of 34 healthy postmenopausal women who would consume cruciferous vegetables daily (Fowke et al., 2000).
- Postmenopausal women seemed to mildly benefit from the daily consumption of strawberries, which resulted in improved blood pressure and circulation, according to an 8 weeks study that included 60 women (Feresin, 2017).
- Phytoestrogen-containing foods such as soybeans, chickpeas, peanuts, flax seeds, barley, grapes, berries, plums, green and black tea
- One study suggested that the consumption of soy have a beneficial effect on bone health; significantly decreasing bone loss among a group of 200 postmenopausal women who consumed 15 g soy protein with on a daily basis for 6 months (Sathyapalan, 2017).
- Another study yet included nearly 250 postmenopausal women and concluded that the daily administration of tablets containing 200 mg of soy for 2 years did not prevent bone loss or hot flashes and other menopausal issues (Levis, 2011).
- Quality protein from sources such as eggs, meat, fish, legumes and dairy products
- In study that included around 900 postmenopausal women, those who ate oily fish and fresh legumes regularly experienced a delayed onset of natural menopause (Dunneram et al., 2018).
- Among a large group of adults older than 50, the risk hip fracture was found to decrease with higher protein intakes from animal, plant and dairy food sources. A 9% lower risk of hip fractures was observed for dairy protein while a 12% lower risk of hip fractures was observed for protein from plant sources (Fung, 2016).
- Women who have a vegetarian diet were younger at menopause compared to non-vegetarians (Dunneram, 2018).
While the above-listed foods relieve the unpleasing effects of menopause, other foods are proven to worsen its issues.
These foods are:
- Added sugars and processed carbs such as white bread, crackers and baked goods
- Women at menopause are at a greater risk of developing insulin resistance, putting them at a greater risk of developing diabetes and easily gaining weight, thus any intake of added sugar is definitely not recommended (Schilling, 2017).
- Early menopause is shown to be associated with greater risks of developing diabetes, insulin resistance and lower glucose metabolism. Added sugars and processed foods are known for rapidly increasing the levels of sugar in the blood, adding to the risks of developing diabetes among menopausal women (Song, 2019).
- Higher blood glucose and insulin resistance – both promoted by higher consumption of sugar and processed food – among nearly 3,000 postmenopausal women over 8 years, were associated with higher incidence of hot flashes (Thurston, 2012).
- Alcohol and Caffeine
- In a population of 72,342 postmenopausal women, daily consumption of 2 servings of soft drinks is associated with a higher risk of hip fracture (Kremer et al., 2019).
- A study including 196 postmenopausal women indicated that the consumption of soft drinks increases the frequency and severity of hot flashes, the consumption of alcohol and coffee increases the severity of hot flashes with no significant predication of their effect over the frequency of hot flashes (Kandiah, & Amend, 2010).
- Spicy foods
- A group of a total of 896 peri- and postmenopausal women, who have a diet including regular hot spicy food intake, reported more frequent and problematic hot flashes (Hunter et al., 2012).
- Salty foods
- Postmenopausal women are a greater risk of developing high blood pressure; thus, reduced consumption of salt may help decrease this risk (Coylewright, 2008).
The daily recommended intake of vitamins and minerals in postmenopausal women is summarized in the table below (Dennehy & Tsourounis, 2010):
|Vitamin or mineral||Recommended intake||Upper limit|
|Vitamin B6||1.5mg (age 50+)||100mg|
|Vitamin B12||2.4mcg||Not established|
|Vitamin D||10mcg (age 51-70)
15 mcg (age 51+)
|Vitamin K||90mcg||Not established|
Healthy postmenopausal women should consider supplementation with specific vitamins and minerals with cautious, since some concerns and side effects were noted in cases of misuse or high intake, according to the following:
- High intake of Vitamin A poses concerns over possible increased fracture risk, which may be more likely in settings of low Vitamin D (Ribaya-Mercado & Blumberg, 2007).
- Vitamin C can cause diarrhea, nausea and stomach cramps, if consumed in doses greater than 3 grams per day (Jacob & Sotoudeh, 2002).
- High intake of Vitamin D is associated, rarely, to hypercalcemia and kidney stones (Brannon, Yetley, & Picciano, 2008).
- High intake of calcium can cause Stomach upset (e.g. constipation, gas, bloating) (Straub, 2007).
- High intake of Vitamin K can rarely cause stomach upset, constipation, and body weight gain (Iwamoto et al., 2009).
- High intake of magnesium is associated with diarrhea
- Excessive selenium levels may increase the risk of hyperlipidemia, hypertension and diabetes
- Excessive zinc levels can cause gastrointestinal upset
Managing menopause through lifestyle adaptations including regular physical activity, enhanced sleep patterns, as well as others, is gaining increased interest (Cutson and Meuleman, 2000). In fact, several women are intrigued by the possibility of relieving the issues associated with menopause through lifestyle and behavioral modifications (AMS, 2019). For example, more emphasis is now placed on alternative approaches, including behavioral or lifestyle modifications for managing the severity and frequency of hot flashes associated with menopause. This is mainly due to the adverse effects associated with medical therapies, including hormone therapies, which are used to treat menopause issues (Grady et al., 2002; Gambacciani et al., 2001).
Sedentary lifestyles are associated with reduced quality of life among middle-aged women who have more severe menopausal issues (Bize et al., 2007). According to several studies reported in the literature, regular physical activity and exercise have been recommended as potential approaches for reducing vasomotor issues and other issues associated with menopause:
- Among a group of 56 women, aged between 50 and 65 years, findings showed that exercising more on a daily basis, which enhances circulation, respiration and reduces waist fat, have a positive impact over a women’s health during menopause (Morardpour et al, 2020)
- In a study done among 48 postmenopausal women aged between 45 to 55 years old who complained of hot flashes, an eight week program of an aerobic exercises was shown to decrease the severity of hot flashes (Elhosary et al., 2018)
- Regular aerobic exercise or training can help improve the quality of life and alleviate the issues associated with menopause, such as decreasing the frequency of hot flashes. For example, a daily high intensity walk, or any equivalent exercise can help reduce the severity of hot flashes (Luoto et al., 2012; Fugate and Church, 2004)
- Some studies reported that engaging in a high level of physical activity or increasing the overall daily physical activity can actually lessen the occurrence of hot flashes in women (Skrzypulec et al., 2010; Guthrie et al., 2005)
- Findings from a study done among a population of 77, 206 postmenopausal women showed that postmenopausal women who carry out light intensity physical exercises, such as walking, are less likely to experience hip and total fractures (LaMonte et al., 2019).
- Findings from a study done on a group of 20 postmenopausal women with stage 1 hypertension showed that postmenopausal women who experience heart diseases can benefit from resistance band training to alleviate the symptoms of the disease as it improves blood pressure and body composition and helps restore the age-associated hormonal decline (Son et al., 2020)
Some lifestyle factors including current smoking have been significantly associated with early and accelerated menopause and were shown to aggravate menopause issues, such as increasing the frequency and severity of hot flashes (Gold et al., 2006; Li et al., 2003); whereas moderate alcohol consumption was associated with delayed age at natural menopause (ANM), among other factors (Sapre & Thakur, 2014).
Evidence from the literature reports findings which show that other lifestyle modifications might lessen the severity of menopause issues:
- Findings from a study done on 761 women aged 45 to 54 years of age at baseline and followed for 1 to 7 years, indicated that smoking increases the risk, severity and frequency of hot flashes. The study reported the benefits of quitting smoking which lessens the effects of menopausal issues, especially those related to hot flashes (Smith et al., 2015).
- Certain lifestyle changes are recommended as primary interventions for managing vasomotor issues with the primary goal of decreasing core body temperature. These recommendations include wearing light cotton clothes or several clothing layers, relying on fans or air conditioners and consuming less hot foods and drinks (Umland, 2008).
- A study tested the efficacy of telephone-delivered cognitive behavioral therapy among a group of 106 menopausal women who reported experiencing poor sleep quality. The study was done over 6 weeks with 8 telephone sessions that delivered information about sleep restriction, stimulus control, sleep hygiene education, and general information about menopause and women’s health. The findings suggested that women who suffer from insomnia and hot flashes can improve their sleep quality through engaging in a telephone-delivered cognitive behavioral treatment (McCurry et al., 2016)
Considering the numerous complications and side-effects associated with the use of prescription medications or hormonal therapies, a lot of women nowadays are transitioning to the use of complementary and alternative medicine to manage their menopausal issues (Johnson et al., 2019; Warnecke, 2011; Brett and Keenan, 2007). Home based remedies, which are part of the alternative medicine approach, are commonly and frequently used. These might include the use of natural remedies and herbs such as soy isoflavones, red clover isoflavones, black cohosh, evening primrose oil and others (Umland, 2008). These treatment options are known to improve the management of menopausal issues; however, there is lack of evidence on their overall efficacy and there is limited data on their general safety (Warnecke, 2011; Rees, 2009; Gollschewski et al., 2004):
- Findings from a study showed that during menopause, women who consume 1000 mg evening primrose oil for 8 weeks on a daily basis, suffered less from issues such as mood swings, irritability, frustration, and physical and mental exhaustion (Sharif and Darsareh, 2020). On the other hand, findings from several studies done so far, showed that primrose oil is ineffective for the treatment of hot flushes (Rees, 2009).
- Black cohosh, is a North American phytopharmaceutical plant and is historically used as a natural treatment option for managing menopausal issues. It is the most commonly used dietary supplement for menopausal hot flashes; however, several studies state that more research is needed to prove the efficacy of this alternative option as it can have several side effects such as gastrointestinal problems, rash, and acute hepatitis (harmful to the liver) (Johnson et al., 2019; Ernst and Posadzki, 2015; Elkins, 2014; Shen and Stearns, 2009).
- Wild Yam plant is a form of traditional Chinese medicine used historically to manage several menopausal issues (Lui et al., 1995). However, more research is needed to prove its efficacy and safety, as the available findings are limited and inconsistent (Johnson et al., 2019; Wojcikowski et al., 2008)
- Dong quai herb is a form of traditional Chinese medicine used historically to manage female reproductive problems. It is most often used in combination with other herbs (Chang and But, 1986). Findings from two studies report that this herb given in combination with other herbs has led to a decrease in the frequency and severity of hot flashes and night sweats and improvement in the sleep quality among post-menopausal women (Rotem and Kaplan, 2007; Kupfersztain et al.,2003). However, more research is needed to study the efficacy and safety concerns that exist regarding Dong quai herb such as the possible interactions with other medications and herbs and possible carcinogenicity (Johnson et al., 2019; Fugh-Berman, 2000).
- Phytoestrogens are plant derived compounds which include soy and red clover (isoflavones), flaxseed and others. Several studies show that the use of such compounds is beneficial in managing menopausal issues. For example, findings from a study done on women who were given dried red clover leaves (40 mg) for 12 weeks showed significant improvements in menopausal issues (Shakeri et al., 2015). Other studies mention that plant isoflavones including soy sources (soybeans, edamame, tofu, and soy milk…) can improve menopause issues, including hot flashes and night sweats (Chen et al., 2015; Healthwise, 2019). However, findings from other studies are contradictory and showed no improvement in managing menopausal issues (Johnson et al., 2019; Lethaby et al., 2013; Atkinson et al., 2004). Also, phytoestrogens appear to be safe for 12 months of continuous use, so more research is needed to support the efficacy and safety (Johnson et al., 2019; Lethaby et al., 2013).
- Ginseng is a widely used herb to enhance the overall wellbeing and immune system by decreasing stress and boosting energy. It is reported to be one of the commonly available herbs for managing menopausal issues and can be consumed in a tea or capsule form (Posadzki et al, 2013; Angelova et al., 2008); However, evidence supporting the efficacy of ginseng is limited and contradictory (Lee et al., 2016; Kim et al., 2013). In fact, findings from a systematic review reported that Ginseng had positive effects on sexual function and arousal and on enhancing sleep patterns and the quality of sleep, but no significant effect on the frequency and severity of hot flashes (Lee et al., 2016).
- French maritime pine bark extract (also called Pycnogenol), is mainly composed of flavonoids which are plant-based hormones and organic chemicals. Some evidence reports that pine bark extract taken as a supplement might lessen the severity of hot flashes and improve other issues such as night sweats, bloating and digestive problems (Errichi et al., 2011)
At midlife, women going through menopause might experience emotions such as irritability, frustration, agitation and anger frequently and unexpectedly.
These emotions are triggered by this life stage changes, experienced by women at all levels.
At a physical level, a drop in sex hormones (estrogen and progesterone), combined to the different issues characteristic of this period (hot flashes, chills, night sweats and others) may cause disruptions.
At an emotional level, distressing family events (losing family members, children moving away), combined to the fear of getting older and to the inability of family and friends to understand and support women going through menopause, can add to the frustration of this period.
Everyone feels sad once in a while, and menopause might be an emotionally and psychologically sensitive and challenging stage for women to navigate through. Research has shown that some support activities and approaches can help women cope with their emotional experiences during menopause. These, besides adequate sleep, regular exercise, nutrition and health habits, include trying relaxation techniques, and seeking support from social groups and from experts.
These include activities that help reduce stress.
- Among a group of 54 late perimenopausal and postmenopausal women, 90 minutes yoga classes offered over a period of 10 weeks resulted in a 66% decrease in the frequency of hot flashes. Comparable results was identified in the group that was assigned a 90 minutes health and wellness education classes that resulted in a 64% decrease in the frequency of hot flashes (Avis et al., 2014).
- Certain relaxation techniques which focus on exercises such as yoga, muscle relaxation and sitting meditation were shown to be effective methods for the self-treatment of hot flashes (Monitor, 2015; Umland, 2008).
- A study including 120 perimenopausal women in India indicated that the normal rehearsal of yoga and meditation are powerful tools in dealing with the troubling manifestations of menopause and improving the personal satisfaction (Swathi, Eswar, & Krishnan, 2019).
- Meditation was found to reduce the frequency and duration of hot flashes and night sweats in postmenopausal women who practiced 2-hour group sessions of gratitude meditation once a week and 25-minute solitary exercises every night over a period of 8 weeks. This effect was sustained over the follow-up period of the study (Borjali et al., 2019).
- Tai chi, as an active form of meditation, is shown to play a role in improving the overall health, well-being, mood, and sleep as well as decreasing stress in peri- and post-menopausal women (Tonob, & Melby, 2017).
- On another study that included 119 postmenopausal women, Tai Chi resistance training was found to slow bone loss (Wang et al., 2015).
- In one study, lavender aromatherapy was found to lessen the undesirable experience of menopause issues for women when smelled two times a day for 20 min over a period of 12 weeks; thus, indicating that aromatherapy massage, among other types of massage, can effectively help women during women (Nikjou, 2018).
- Overall evidence from the literature demonstrates that acupuncture improves menopausal hot flashes, as identified through an assessment if randomized controlled trials and systematic reviews that looked into the impact of acupuncture on menopausal hot flashes (Ee et al., 2017).
- Among a total of 70 women with moderate-to-severe menopausal issues, the group of 36 women that received one acupuncture session for five consecutive weeks reported a significant decrease of hot flashes, day-and-night sweats, general sweating, and in menopausal-specific sleeping problems, emotional issues, physical issues and skin and hair issues in comparison to the control group of 34 women who received the acupuncture session at the 6-week follow-up (Lund et l., 2019).
- Among 60 postmenopausal women with at least 7 moderate to severe hot flashes per day, those who were taught the applied relaxation technique for adequate breathing experienced hot flashes less frequently. The applied relaxation is based on cognitive-behavioral therapy, it focuses on muscle relaxation through right breathing. In this group, the application of this technique reduced the number of hot flashes from an average of 7 per day to an average of 2 per day, which was sustained at a post-intervention measurement at 3 months (Lindh-Åstrand & Nedstrand, 2013).
- Breathing exercises such as slow and deep abdominal breathing for around 15 minutes twice a day, can decrease feelings of anxiety that occur with hot flashes. However, this practice is not reported to reduce the severity of those hot flashes (Carpenter et al., 2013).
Other complementary health approaches including traditional Chinese medicine (TCM) and the traditional Japanese medicine (Kampo) are also used by menopausal women to alleviate the issues associated with this life transition (Tonob, & Melby, 2017).
Family and friends can provide a valuable social support and network for women during the menopause transition. The need to educate and counsel both women and husbands during this stage was document in the literature (Namazi, Sadeghi, & Moghadam, 2019). Another valuable social support can be provided by other women in the community who are also going through menopause. It was actually proven that emotional and social support play an important role in promoting women’s health during menopause (Namazi, Sadeghi, & Moghadam, 2019).
The transition through menopause might induce feelings of isolation and of being misunderstood by family and friends. For this reasons, women might prefer seeking support from trained experts and therapists to help them better cope with the challenges experienced at this stage. Different therapy approaches, besides the traditional cognitive behavioral therapy, were proven to be efficacious in the literature:
- A study tested the efficacy of telephone-delivered cognitive behavioral therapy among a group of 106 menopausal women who reported experiencing poor sleep quality. The study was done over 6 weeks with 8 telephone sessions that delivered information about sleep restriction, stimulus control, sleep hygiene education, and general information about menopause and women’s health. The findings suggested that women who suffer from insomnia and hot flashes can improve their sleep quality through engaging in a telephone-delivered cognitive behavioral treatment (McCurry et al., 2016).
- Brief unguided self-help cognitive behavioral therapy booklets can effectively help working women manage their experience of hot flashes and night sweats, according to one study. This study included a total of 124 working women, among which 60 women were provided a self-help cognitive behavioral therapy booklet. The results showed that this group experienced less hot flashes and night sweats, improved work and social life, better sleep and menopause beliefs 6 week into the study; and experienced a general improved wellbeing and work performance 20 weeks into the study (Hardy et al., 2018).
Menopause is associated with a gradual decline of primordial ovarian follicles and estrogen deficiency. This transition results in a permanent cessation of the woman’s menstrual cycle and is experienced by around 1.5 million women each year, in which the median age is reported to be 51 years old (Polo-Kantola & Rantala, 2019; Cohen et al,. 2006; Dennerstein et al., 2000; WHO, 1996). The most experienced health conditions at menopause include bone loss, cancer, heart disease and mental health issues.
Basic terms used widely in the different menopause phases experienced in each woman’s life are defined according to the following:
- The whole reproductive period of a woman’s life prior to menopause is referred to as the “Premenopause” phase (Smith & Contestabile, 2002).
- The occurrence of gradual hormonal changes along with changes in the menstrual cycle represents the “Menopausal Transition” phase (NAMS, 2000).
- The period directly before the menopause phase and the first year after menopause is referred to as the “Perimenopause” phase (Smith & Contestabile, 2002).
- The period including the years after the final menstrual period resulting from natural or premature menopause is referred to as the “Postmenopause” phase (Soules et al., 2001)
- Cases where menopause first begins in women aged 39 years or less are referred to as “Premature menopause” (NAMS, 2000).
- Cases where the menstrual cycle stops for medical reasons such as surgical removal of both ovaries or iatrogenic ablation of ovarian function is referred to as “Induced menopause” (NAMS, 2000).
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