The ovary primarily produces estrogen, progesterone, and androgens. As a woman ages, the process of atresia reduces the number of oocytes, so that at the time of menopause a woman may have only a few hundred to a few thousand oocytes left. Pregnancy must always be considered in the differential diagnosis of secondary amenorrhea.Ī female ovary has the greatest number of oocytes during the fifth month of gestation and has about 1 to 2 million oocytes at birth. Secondary causes of POI include chromosomal abnormalities (e.g., fragile X syndrome), autoimmune disorders, physical insults to the ovaries, isolated ovarian antibodies, and gonadotropic receptor defects. There are many reasons for secondary amenorrhea in addition to primary ovarian failure. Premature ovarian insufficiency (POI) is the cessation of ovarian function before the age of 40. The North American Menopause Society has published a comprehensive online study guide related to menopause and offers testing to credential menopause practitioners. Systems affected by the perimenopausal phase include skin and hair, genitourinary (GU), neuroendocrine, cardiovascular, and skeletal. The change in hormones during this period is often responsible for the clinical signs and symptoms that many women experience. It is a progressive process that eventually leads to persistent ovarian failure. Menopause transition consists of fluctuating ovarian function and occurs 2 to 8 years before menopause and up to 1 year after the final menses. Smokers and women with chronic illnesses tend to experience menopause at an earlier age ( Box 1). Women usually experience menopause between 40 and 55 years of age, with the median age being 51. Menopause is defined as the absence of menses for 1 year.

Adrenal gland estrogen production