The profile of female geriatric patients will be changing considerably over the next decade. A substantial number of women born during the baby boom following World War II are at or beyond midlife, resulting in an increasing number of women who will be seeking treatment for symptoms associated with menopause and for chronic conditions that have their origin in midlife (see Chapter 5 for details on demographics). Further, the cohort of U.S. women who are now at midlife is unique. More than three-quarters are in the workforce; more than one-third have college degrees; and family composition has changed remarkably as evidenced by the number of live births that have declined by almost half.
For many of these women, the midlife, which encompasses the menopausal transition, will be a significant milestone and a harbinger of their health status and their interaction with health care systems for the ensuing decades. Thus, it is important to understand the events of the menopause transition and that these events are likely to affect health, the perception of health, and the perception of the contribution of the health care provider to health maintenance.
The initiation of the menopause transition (that time from active reproduction to the cessation of significant estrogen secretion because of the depletion of functional ovarian follicles) is an ill-defined period that commences with the onset of menstrual irregularity or skipped menses and ends 12 months following the final menstrual period (FMP). The median age at FMP is currently estimated to be 51.4 years. The menopause itself is the permanent cessation of menses and is clinically diagnosed following 12 continuous months of amenorrhea.
This geriatrics textbook includes a chapter on menopause because exposure to declining levels of ovarian hormones appears to modify risk factors associated with the development of debilitating diseases and health concerns of the geriatric patient. Furthermore, the menopause transition may represent an optimal time for clinical intervention. These clinical interventions can address two potential patient groups: (1) the 12% to 25% of women who already have some evidence of disability (see the physical limitations section) and for whom active interventions are critical and (2) the majority of women who are not disabled and are open to information about preventive care, risk factor screening, and maybe seeking care for menopausal symptoms.
Aging of the female reproductive system is unique because the timeframe for the permanent cessation of menses has changed little over time, while the average life expectancy of women now extends to more than 30 years after the FMP. Further, women have a finite period of reproductive capacity. Unlike men, who usually retain reproductive capacity throughout their lifetime, women are born with a set number of primordial follicles, whose depletion begins prior to birth (Figure 46-1). At menopause, when a woman's ovarian reserve is depleted, the number of available follicles recruited to form preovulatory follicles has dwindled to a point where ovarian-based hormones, including ...