[Natural history of menopause]

Etymologically meaning "cessation of menstruation", the menopause is in fact a phenomenon which occurs over several years and can be divided into two phases: a period of "pre"-menopause, approximately from the age of 40 to 50, during which ovulation becomes increasingly less frequent, leads to decreased fertility and progesterone deficiency (luteal insufficiency), whereas the confirmed "menopause", which occurs between the age of 50 and 55, is the disappearance of all follicles, leading to estrogen deprivation. The risk associated with the "pre"-menopause is an "unopposed estrogen effect", with its cellular effects on target-tissues. The problem of confirmed menopause is decreased tissue trophicity, not only of the genital area, but of the body in general (skin, bone, blood vessels, etc.) as a consequence of estrogen deprivation. Replacement therapy is the logical treatment: progestins during the "pre"-menopause, estrogens in combination with progestins once "menopause" is confirmed.