Ways of assessing the impact on women of some of these<unk>  effects, include the Greene climacteric scale questionnaire, the Cervantes scale and the<unk>  rating scale. Premenopause Premenopause is a term used to mean the years leading up to the last period, when the levels of reproductive hormones are becoming more variable and lower, and the effects of hormone withdrawal are present. Premenopause starts some time before the monthly cycles become noticeably irregular in timing. Perimenopause The term "perimenopause", which literally means "around the<unk> ", refers to the<unk>  transition years before the date of the final episode of flow. According to the North American<unk>  Society, this transition can last for four to eight years. The Centre for Menstrual Cycle and Ovulation Research describes it as a six- to ten-year phase ending 12 months after the last menstrual period. During perimenopause, estrogen levels average about 20–30% higher than during premenopause, often with wide fluctuations. These fluctuations cause many of the physical changes during perimenopause as well as<unk> , especially during the last 1–2 years of perimenopause (before<unk> . Some of these changes are hot flashes, night sweats, difficulty sleeping, mood swings, vaginal dryness or atrophy, incontinence, osteoporosis, and heart disease. During this period, fertility diminishes but is not considered to reach zero until the official date of<unk> . The official date is determined retroactively, once 12 months have passed after the last appearance of menstrual blood. The<unk>  transition typically begins between 40 and 50 years of age (average 47.5). The duration of perimenopause may be for up to eight years. Women will often, but not always, start these transitions (perimenopause and<unk>  about the same time as their mother did. In some women,<unk>  may bring about a sense of loss related to the end of fertility. In addition, this change often occurs when other stressors may be present in a woman's life: * Caring for, and/or the death of, elderly parents * Empty nest syndrome when children leave home * The birth of grandchildren, which places people of "middle age" into a new category of "older people" (especially in cultures where being older is a state that is looked down on) Some research appears to show that melatonin supplementation in perimenopausal women can improve thyroid function and gonadotropin levels, as well as restoring fertility and menstruation and preventing depression associated with<unk> . Postmenopause The term "postmenopausal" describes women who have not experienced any menstrual flow for a minimum of 12 months, assuming that they have a uterus and are not pregnant or lactating. In women without a uterus,<unk>  or postmenopause can be identified by a blood test showing a very high FSH level. Thus postmenopause is the time in a woman's life that takes place after her last period or, more accurately, after the point when her ovaries become inactive. The reason for this delay in declaring postmenopause is that periods are usually erratic at this time of life. Therefore, a reasonably long stretch of time is necessary to be sure that the cycling has ceased. At this point a woman is considered infertile; however, the possibility of becoming pregnant has usually been very low (but not quite zero) for a number of years before this point is reached. A woman's reproductive hormone levels continue to drop and fluctuate for some time into post-menopause, so hormone withdrawal effects such as hot flashes may take several years to disappear. A period-like flow during postmenopause, even spotting, maybe a sign of endometrial cancer.
Menopause
Somatopause
Adrenopause
Menstruation
Premenstrual syndrome
Lactational amenorrhea
Menarche
Pregnancy