Glossary of Medical Terms Used in Menopause: The Inside Info
These are short definitions and graphics to be used as a quick reference tool. New entries will continue to be added.
There is also a guide at the end to help you find a menopause expert.
Menopause Definitions
Early menopause. Although it is normal for a woman to go through menopause in her early 40s, it occurs spontaneously in only 3% to 5% of women and is considered to be an early menopause. Most early menopause is a consequence of surgery.
Induced menopause. This is menopause that occurs because of surgical removal of the ovaries or because of a cancer treatment, such as pelvic radiation or chemotherapy. Women who have an induced menopause do not go through perimenopause.
Menopause. Menopause is defined as the final menstrual period, which is confirmed once someone has not had a period for 12 months. Of course, for women who do not have periods (due to hysterectomy, uterine ablation, IUD), this is not a useful benchmark. Essentially, menopause is when the ovaries are no longer producing ovarian hormones, primarily estrogen. The average age of menopause in the United States is 52, but it is normal to enter menopause any time after age 40.
Perimenopause. This is the time leading up to menopause, when hormones start to fluctuate, and periods are unpredictably irregular. Any symptoms experienced during menopause can occur during perimenopause. Perimenopause can last weeks, months, or years, but it is officially over when a menstruating woman has been without a period for 12 months.
Post-menopause. This refers to life after you enter menopause. You are post-menopause until you die.
Premature menopause. This is menopause that occurs at or before the age of 40. In many cases, this is genetic, but it may also be the result of an autoimmune disease or have been induced by surgery or cancer treatments.
Premenopausal. Premenopause starts with puberty and continues until perimenopause. A 15-year-old is considered to be premenopause.
Primary ovarian insufficiency (POI). This is defined as when the ovaries wind down before the age of 40. It may be permanent, in which case it is premature menopause, or it may be temporary. POI is not the same as premature menopause. Premature menopause is permanent. In POI, ovarian activity kicks in again. This is common during cancer treatment.
Spontaneous (natural) menopause. This is menopause that is not caused by medical treatment, surgery, radiation, or chemotherapy.
Surgical Menopause. Surgical menopause occurs when the ovaries are surgically removed. Hysterectomy does NOT cause a surgical menopause unless the ovaries are removed along with the uterus.
A
Anandamide (AEA). An endocannabinoid made in humans that, in addition to a number of other functions, also helps regulate body temperature.
Androgens. Hormones, such as testosterone, androstenedione, and dehydroepiandrosterone (DHEA), that are associated with male sex characteristics and structures but are also produced in smaller quantities in women. Androgens play a role in sexual function, muscle mass, bone density, distribution of fat tissue, energy, and psychological well-being. In women, most androgen production is divided between the ovaries and adrenal glands.
Androgenetic alopecia. Thinning of the hair on the scalp. Though common in peri- and post-menopausal women, the actual cause is unknown. Genetic predisposition, hormone levels, and stress all might be factors.
Anti-Mullerian hormone (AMH). Blood levels of anti-Mullerian hormone have been used by fertility specialists for years to evaluate ovarian reserve—essentially, how good eggs are, and how long they will be functional. AMH declines with age as the “good” egg pool decreases and is completely gone after menopause. Sometimes AMH is used as a predictor for when someone is going to go into menopause because levels are known to drop roughly five years before menopause. But at this time, these measures are not reliable.
Aromatase inhibitors. A class of prescription drugs used for the prevention and treatment of breast cancer. Aromatase inhibitors work by blocking the formation of estrogen in the body’s tissues.
B
Bazodoxifene (BZA). A selective estrogen receptor modulator (SERM) that helps protect the uterine lining from the thickening that may occur in women who take estrogen.
Bilateral oophorectomy. Oophorectomy refers to the surgical removal of the ovaries. Bilateral specifies removal of both ovaries.
Bilateral salpingo-oophorectomy. The surgical removal of both the ovaries and fallopian tubes.
Bioidentical Estrogens Bioidentical estrogen is structurally identical to the estradiol made in ovaries. Bioidentical estradiol is found in both commercial and compounded products. The bioidentical estrogen you get in a compounded estrogen is identical to bioidentical estrogen in an FDA-approved commercial product. Bioidentical estrogens don’t always come from plants. They can also be synthesized entirely in the laboratory or extracted from animals. The chemical structure of the molecule, which is chemically identical to the estradiol humans naturally make, not the originating source, determines whether a hormone is bioidentical.
C
Cannabidiol (CBD). CBD is extracted from hemp flowers. It does not have psychoactive properties, so it will not get you high. CBD contains trace amounts of THC. CBD may decrease pain and inflammation in addition to helping you get a good night’s sleep.
Cholesterol. A fat-like substance used by the body to make hormones, vitamin D, and substances that help you digest foods. Cholesterol also is found in some foods.
Clonidine. A prescription drug that is FDA approved to lower high blood pressure but is sometimes prescribed off label to treat hot flashes.
Commercially produced bioidentical estrogen. Plant-derived beta-estradiol, which is essentially identical to the estrogen produced by the ovaries. These products are FDA approved and are taken by mouth as a pill; transdermally as a patch, gel, or spray; or via a disposable vaginal ring.
Congestive heart failure. A condition in which the heart is unable to maintain adequate circulation of blood in the body.
Conjugated estrogens (CE). A mixture of estrogen hormones used to treat symptoms of menopause. Conjugated estrogens are mixtures of different types of estrogens. Some are plant-derived. Some are derived from pregnant horse urine. Some are entirely synthesized in the laboratory
Coronary artery disease (CAD). Sometimes called coronary heart disease (CHD), this is the most common form of heart disease. CAD refers to damaged or diseased blood vessels that supply blood to the heart. See also cardiovascular disease (CVD).
Coronary heart disease (CHD). See coronary artery disease (CAD).
Compounded bioidentical estrogen. Plant-derived beta-estradiol, which is essentially identical to the estrogen produced by the ovaries and identical to the estradiol in commercial products. Compounded products are not FDA approved and are distributed by independent compounding pharmacies. Compounded estrogen is administered through the skin as a lotion or gel, or via a pellet placed under the skin.
Commercially produced conjugated or synthetic estrogen. Conjugated estrogens are mixtures of manmade or natural estrogens. Synthetic estrogen or conjugated estrogens are derived from a plant source. Conjugated equine estrogen is composed of multiple estrogens derived from the urine of pregnant horses. Most of these products are now off the market due to the emergence of bioidentical products.
Cystitis. Inflammation of the urinary bladder. See also urinary tract infection.
Cystocele. Protrusion of the urinary bladder.
D
Dehydroepiandrosterone (DHEA). An androgen produced mainly in the adrenal glands. It is a precursor of androstenedione, testosterone, and estrogen. DHEA decreases with age, not menopause.
Dyspareunia. Pain during intercourse
E
Endocannabinoid receptors. Required for endocannabinoids to become active. CB1 receptors are mostly found in the central nervous system (brain and spinal cord) but are also in the reproductive system, heart, lungs, skin, and adrenal glands. CB2 receptors are found in the liver, bones, spleen, digestive tract, peripheral nervous system, and immune system. Hot Flash Hell: A Gynecologist’s Guide to Turning Down the Heat
Endocannabinoid system. A complex nerve-signaling system composed of neurotransmitters that bind to cannabinoid receptors. It is responsible for regulating multiple body functions, including appetite, metabolism, pain, mood, learning, memory, sleep, bone health, cardiovascular health, and stress.
Endometrial ablation. A surgical procedure in which heat energy is used to destroy the lining (endometrium) of the uterus to treat heavy bleeding.
Endometrial biopsy. A sample of endometrial (uterine lining) tissue is removed through the opening of the cervix and examined microscopically for abnormal cells.
Endometrial cancer. Cancer of the inner lining (endometrium) of the uterus.
Endometrial hyperplasia. An overgrowth of tissue or a thickening of the uterine lining often caused by excess estrogen. It is a risk factor for cancer of the uterus.
Endometrium. The tissue that lines the cavity of the uterus.
Estradiol. Also called 17β-estradiol. It is the most potent of the naturally occurring estrogens and the primary estrogen produced by the ovaries during the reproductive years.
Estriol. The least potent of the estrogens produced in the body.
Estrogen. Hormone compounds produced by the ovaries. The three main naturally occurring estrogens in women are estradiol, estrone, and estriol.
Estrone. A weak form of estrone is produced in the ovaries and fat.
Estrogen therapy (ET). A general term describing systemic and local formulations in oral, skin patch, and vaginal prescriptions. ET specifically refers to hormone therapy that does not include a progestogen. See also systemic estrogen therapy, local estrogen therapy.
F
Fibrinogen. A protein in the blood that helps it clot.
Follicle-stimulating hormone (FSH). A hormone produced by the pituitary gland, which is located at the base of the brain. FSH stimulates production of estrogen by the ovaries and, during the reproductive years, stimulates the growth of ovarian follicles (the small cysts that hold the eggs). During perimenopause, FSH levels fluctuate. Once a woman has entered menopause and estrogen production has ceased, FSH levels remain high.
Formication. Many perimenopausal women experience skin sensations such as itching or the feeling that there are “ants crawling” on their skin. This phenomenon is known as formication.
G
Gabapentin. A nonhormonal prescription drug usually prescribed for the treatment of seizures but sometimes prescribed off label for treating hot flashes.
Genitourinary Syndrome of Menopause or GSM, is the medical terminology that was introduced in 2013 to describe the physical changes and symptoms that occur in the vagina, vulva and lower urinary tract.
Gonadotropin-releasing hormone (GnRH). A hormone released by the hypothalamus (a region in the brain) that inhibits ovarian production of estrogen.
H
High-density lipoprotein cholesterol (HDL-C). Referred to as the “good” cholesterol. High HDL-C helps to lower the risk of heart disease.
Hormone Therapy-HT. Anytime you add hormones to the body, in any amount, it is hormone therapy. The most common form of hormone therapy prescribed in the United States is birth control pills. Hormones prescribed post menopause are another category of HT. HT may include estrogen, progestogen, and sometimes testosterone.
Hormone Replacement Therapy-HRT. Hormone replacement therapy replaces a hormone that the body no longer makes, in a dosage that matches the level the body used to make on its own. HRT is no longer the appropriate terminology to use when referring to hormones that are prescribed post menopause. The proper term is either HT or MHT
Husband replacement therapy (HRT). In addition to HT, often necessary for sexual satisfaction and quality of life.
Hybrid cannabis. A hybrid cannabis plant has aspects of indica and sativa. The interbreeding of these hybrid strains has become so common that some say the unique distinctions between indica and sativa no longer exist.
Hypertension. Abnormally high blood pressure.
Hypoactive sexual desire disorder (HSDD). Problems with sexual desire, arousal, orgasmic response, and sexual pain. Between one-third and one-half of perimenopausal and post-menopausal women experience these problems.
Hysterectomy. Surgical removal of the uterus. Does not result in menopause but ends menstrual periods and fertility. The term is often mistakenly used to describe the removal of the uterus and both ovaries, which results in surgical menopause.
Hysteroscopy. A surgical procedure to examine the inside of the uterus by inserting a thin, lighted tube into the vagina and through the cervix (the lower, narrow end of the uterus).
I
Incontinence. Involuntary loss of urine or stool.
Indica. This species of cannabis comes from a short, bushy plant and is anecdotally known for its calming attributes. Indica is used for pain relief, sleep, and relaxation and is best taken at night.
Intrauterine device (IUD). Also called an intrauterine system (IUS). A small device with either progestin or copper that is placed in the uterus by a healthcare provider. Though primarily used for contraception, the levonorgestrol IUD is also used to control perimenopausal heavy bleeding and, off label, to protect the uterine lining in a woman taking post-menopause estrogen therapy.
Isoflavones. Naturally occurring, estrogen-like compounds found in soybeans, soy products, and red clover.
L
Lichen sclerosus. A condition that causes thinning of the vulvar skin along with symptoms such as itching, burning, and painful sexual activity. Treatment is regular surveillance and topical corticosteroids. There is an association of lichen sclerosis with vulvar cancer.
Local vaginal estrogens. Creams, tablets, vaginal rings, inserts, or suppositories placed in the vagina to specifically alleviate the symptoms of vaginal atrophy and genitourinary syndrome of menopause. Although some vaginal estrogen is absorbed into the bloodstream, the amount is minimal, and its effects are local rather than systemic. For that reason, vaginal estrogen has no impact on your hot flashes, bones, or brain.
Low-density lipoprotein cholesterol (LDL-C). The “bad” cholesterol. Elevated LDL-C increases the risk of heart disease.
Luteinizing hormone (LH). A hormone produced by the pituitary gland (located at the base of the brain) that triggers the release of an egg from the ovary (ovulation). LH levels rise during menopause.
M
Metabolic syndrome. A condition characterized by the presence of three or more of the following factors: central obesity (increased waist circumference), elevated triglyceride levels, low HDL-C, elevated blood pressure, and/or an elevated fasting glucose level. Women with metabolic syndrome are at increased risk for heart disease, stroke, and type 2 diabetes (adult-onset diabetes).
Menopausal Hormone Therapy-MHT. The correct terminology for post-menopause hormone therapy is menopausal hormone therapy, MHT. MHT is a specific type and level of hormone therapy that is intended to supply small amounts of estrogen, progesterone, and sometimes testosterone because the ovaries are no longer producing them. Small amounts of hormones are used to alleviate symptoms like hot flashes or consequences of estrogen deprivation like bone loss. Local vaginal estrogen applied to the vulva or vagina to treat vaginal dryness, painful sex, and bladder symptoms like urgency or recurrent urinary tract infections is another form of MHT. The amounts that are prescribed are not meant to reach pre-menopause hormone levels.
N
NAMS menopause practitioner. A licensed healthcare clinician who has achieved a certification in the field of menopause from the North American Menopause Society by passing a competency examination.
Nonsteroidal anti-inflammatory drugs (NSAIDs). A class of non-narcotic, over-the-counter drugs that provide painkilling, fever-reducing, and, in higher doses, anti-inflammatory effects. Examples of commonly used NSAIDS are aspirin, ibuprofen, and naproxen.
O
Off label. Refers to the use of a drug to treat a condition for which it has not been FDA-approved. As an example, when birth control pills are used to alleviate menstrual cramps, that is an “off-label” use since birth control pills are only FDA-approved to prevent pregnancy.
Ospemifene. An oral medication used to treat vaginal dryness and painful intercourse. It is a selective estrogen receptor modulator (SERM).
P
Paroxetine. A selective serotonin reuptake inhibitor (SSRI) used to treat depressive and general anxiety disorders. Low-dose paroxetine is FDA-approved for the treatment of hot flashes. Higher doses are sometimes used off-label to treat flashes.
Pellets. A hormone pellet is a tiny capsule, that is a delivery system for hormones such as estrogen and testosterone. The pellet is injected and implanted under the skin, usually in the hip or buttock, and releases hormones directly into the bloodstream. The pellet dissolves over time and a new one is inserted every 4-6 months. Pellets are associated with multiple side effects such as facial hair, male pattern baldness, enlargement of the clitoris, lowering of the voice and uterine cancer.
pH. Vaginal pH is a measurement of the acidity level in the vagina. A healthy vagina has a low pH -3.5-4.6- which allows healthy bacteria to thrive and populate the vagina.
Phytocannabinoids. A cannabinoid extracted from the marijuana plant, aka cannabis. Phytoestrogens. Plant compounds (such as isoflavones) that have a chemical structure similar to that of estrogen and have weak, estrogen-like biological activity. Available in foods (such as soy) and as nonprescription supplements. See also isoflavones. Placebo. An inactive substance used in controlled experiments to determine the effectiveness of a drug or other substance in comparison.
Progesterone. The naturally occurring hormone normally produced by the ovaries after a woman ovulates.
Progestin. Any synthetic form of progesterone. Progestins are commonly used in hormonal forms of contraception, such as birth control pills, implants, and IUDs, but they are also used in lower doses for menopause hormone therapy. Progestins used in FDA-approved products include drospirenone, levonorgestrel, medroxyprogesterone acetate (MPA), norethindrone acetate, and norgestinate.
Progestogen. A general term that includes all compounds that bind to progesterone receptors. Progestogens include both naturally occurring progesterone and synthetic progestins.
R
Rugae. Vaginal Rugae are accordion-like folds in the walls of the vagina that allow for expansion during intercourse. With the loss of estrogen, vaginal walls often lose this wrinkly appearance and become very smooth.
S
Sativa. The sativa species of cannabis is a tall, slim plant. It is often used during the day because it is purported to boost energy, increase focus, and be overall stimulating instead of sedating.
Selective estrogen-receptor modulator (SERM). A compound that has a similar chemical structure to estrogen and either blocks estrogen receptors or stimulates them. SERMs can have an estrogen-like effect on some tissues and an antiestrogen effect on others.
Selective serotonin-reuptake inhibitor (SSRI). A commonly prescribed class of antidepressants that blocks the reabsorption (reuptake) of the neurotransmitter serotonin in the brain. SSRIs are often used off-label to treat hot flashes.
Selective norepinephrine-reuptake inhibitor (SNRI). A commonly prescribed class of antidepressants that blocks the reabsorption (reuptake) of the neurotransmitter norepinephrine in the brain. SNRIs are often used off-label to treat hot flashes.
Stress incontinence. Involuntary loss of urine that occurs when someone coughs, sneezes, laughs, or exercises.
Study of Women’s Health Across the Nation (SWAN). A study of over 3,000 midlife women started in 1994 and is ongoing. Caucasian (46%), Black (28%), Hispanic (9%), and Asian (17%) American women between the ages of 40 and 55 from all over the country were enrolled to study midlife health, the impact of menopause, and hormone therapy. The data continues to roll in, and more than any other study, it has informed us about the impact of menopause and hormones on health. SWAN data also includes the effects of smoking, diet, medications, hormone therapy, and multiple psychosocial variables. Much of the information in the Inside Information Series is derived from SWAN. If you would like to take a look at this information yourself, all of the data is published on the SWAN website, https://www.swanstudy.org/
Synthetic Estrogens. Synthetic estrogens are entirely produced in the laboratory. If you have ever used birth control pills, you have taken synthetic estrogens. Synthetic estrogen is found in many forms of menopausal hormone therapy. Examples are Femhrt™ and Jinteli. ™
Systemic estrogen therapy. Estrogen therapy that works throughout the body to alleviate symptoms such as hot flashes. The blood level you achieve with estrogen therapy is not intended to be as high as when you were 20 (which is why it is called estrogen therapy or hormone therapy, as opposed to estrogen replacement therapy or hormone replacement therapy) but high enough to alleviate symptoms. A systemic estrogen may be oral (a pill), or it may be transmitted through the skin (transdermal) in the form of a spray, patch, gel, or cream. One vaginal product, Femring™, delivers systemic-level doses in the same range as transdermal and oral products.
T
Tamoxifen. A prescription selective estrogen-receptor modulator (SERM) that is prescribed for the prevention and treatment of breast cancer in high-risk women.
Testosterone. A hormone essential for sperm production, secondary sex characteristics, and other functions in men. In women, testosterone contributes to lubrication and libido, and it may also help maintain bone and muscle health.
Tetrahydrocannabinol (THC). The psychoactive component of cannabis. It activates CB1 receptors and can create a euphoric feeling. THC mimics some aspects of anandamide, the endocannabinoid that helps regulate body temperature, which is theoretically why THC may be the key to reducing hot flashes.
Transdermal estrogen. Estrogen therapy delivered through the skin into the bloodstream via a skin patch or topical lotion, spray, cream, or gel.
U
Urge incontinence. Involuntary leakage of urine accompanied by a sense of urgency.
Urinary incontinence. Involuntary loss of urine. See also incontinence, stress incontinence, urge incontinence.
Urinary tract infection (UTI). Sometimes called cystitis, a UTI is when bacteria in the urinary tract cause infection and inflammation. Typical symptoms are urgency and pain with urination.
Urogynecologist. A gynecologist with additional training in incontinence and pelvic relaxation problems, such as prolapse.
V
Vaginal estrogen therapy. See local estrogen therapy
Vaginal atrophy. A condition in which estrogen loss causes the tissues of the vulva (the external parts of the female genital organs) and the lining of the vagina to become thin, dry, and less elastic. See also genitourinary syndrome of menopause.
Vaginal estrogen. Prescription estrogen therapy that is applied vaginally (as a cream, ring, suppository, or tablet) to treat vaginal dryness and atrophy. Most vaginal estrogen therapies provide local, not systemic, treatment. See also local therapy.
Vaginal lubricant. Over-the-counter products applied to the opening of the vagina to decrease friction and reduce pain during intercourse.
Vaginal moisturizer. Over-the-counter products that increase the water content of vaginal cells to increase lubrication and elasticity. Moisturizers are intended to be used on a regular basis in anticipation of sexual activity.
Vasomotor symptoms. Commonly known as hot flashes, vasomotor symptoms specifically refer to changes in the diameter of blood vessels that cause a change in body temperature and speed up your heart rate.
Vulva. The external parts of the female genitalia, including the tissue around the opening of the vagina.
W
Women's Health Initiative (WHI). A large study that looked at the impact of oral estrogen on cardiovascular disease, stroke, breast cancer, osteoporosis, colon cancer, and other conditions.
To Find a Menopause Clinician
Read this for more detailed information about how to find a menopause expert:
Read this for questions to ask to know if someone is an expert
The Menopause Society- Certified Menopause Practitioner List Menopause.orgTo find a menopause practitioner: https://portal.menopause.org/NAMS/NAMS/Directory/Menopause-Practitioner.aspx
Put in your zip code and designate NCMP or CMSP to get a certified menopause practitioner. While all people on this list have passed a competency examination, Dr. Streicher does not vouch for every one of these clinicians. Most are excellent.
Midi Health www.Joinmidi.com
Midi Health is a telehealth company that provides high-level menopause care and takes insurance in all 50 states. Dr. Streicher is Midi’s Medical Director of Education and Community Outreach and is familiar with their medical protocols, which are all regularly updated and set by the top academic menopause experts in the country.
Major Medical Centers
Check with major medical centers in your area. Many have menopause clinics or lists of doctors who have an interest and expertise in menopause.
The Northwestern Medicine Center for Sexual Medicine and Menopause Sexmedmenopause.nm.org
If you are in the Chicago area, this is the center founded by Dr. Streicher. She is no longer affiliated with the center.