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The evolutionary origin and significance of menopause

Pollycove, Ricki MD, MS, NCMP, FACOG1; Naftolin, Frederick MD, PhD, FACOG, FRCOG2; Simon, James A. MD, CCD, NCMP, FACOG3

doi: 10.1097/gme.0b013e3181ed957a
Personal Perspective

Contemporary women have long life expectancy (81 y, United States), especially relative to the age at menopause (51 y, United States). Menopause is a consequence of reproductive aging and follicular depletion (ovarian failure), yielding very low circulating estrogen serum concentrations and biologically disadvantageous metabolic alterations. Stated in terms of antagonistic pleiotropy, the ongoing hypoestrogenic endocrine environment, beneficial during lactation, results in acceleration of several age-related illnesses after menopause (ie, late postmenopausal osteoporosis, cardiovascular disease, and cognitive decline). Specifically, the similar hypoestrogenic hormonal milieu present during postpartum lactation provides biologic advantages (fitness) to both mother and newborn. These precepts of evolutionary medicine encourage a reassessment of hormone therapy, and on the basis of data presented the authors propose additional opportunities for disease prevention and morbidity reduction in postmenopausal women.*

From the 1California Pacific Medical Center, San Francisco, CA; 2Obstetrics and Gynecology, New York University School of Medicine, New York, NY; and 3Obstetrics and Gynecology, George Washington University, Washington, DC.

Received February 3, 2010; revised and accepted June 15, 2010.

Funding/support: Funded in part by a grant from the National Institutes of Health, Institute on Aging Workshop on Aging, June 2009.

Financial disclosure/conflicts of interest: Ricki Pollycove: advisory board for Teva/Duramed/Barr and Corcept Therapeutics, Inc. Speaker bureau for Aventis, Novo Nordisk, Ther-Rx, Upsher-Smith, Noven. Author, Pocket Guide to BioIdentical Hormones, 2010, Alpha Press. Fred Naftolin: member of the Speaker Advisory Board (SAB) for Se-Cure Inc., who markets Femarelle. James A. Simon: consultant or on the advisory boards of Allergan (Irvine, CA), Alliance for Better Bone Health (Cincinnati, OH), Amgen Inc. (Thousand Oaks, CA), Ascend Therapeutics (Herndon, VA), Bayer (Leverkusen, Germany), BioSante (Lincolnshire, IL), Boehringer Ingelheim(Ingelheim, Germany), Concert Pharmaceuticals (Lexington, MA), Corcept Therapeutics, Inc. (Menlo Park, CA), Depomed, Inc. (Menlo Park, CA), GlaxoSmithKline (Philadelphia, PA), KV Pharmaceutical Co. (St Louis, MO), Lipocine, Inc. (Salt Lake City, UT), Meditrina Pharmaceuticals (Ann Arbor, MI), Merck (Whitehouse Station, NJ), Merrion Pharmaceuticals (Wilmington, NC), Nanma/Tripharma/Trinity (Glen Arm, MD), NDA Partners LLC (Lakewood Ranch, FL), Novo Nordisk (Bagsvrerd, Denmark), Novogyne (East Hanover, NJ), Pear Tree Pharmaceuticals (Cambridge, MA), QuatRx Pharmaceuticals (Ann Arbor, MI), Roche (Basel, Switzerland), Schering-Plough (Kenilworth, NJ), Sciele (Atlanta, GA), Solvay (Marietta, GA), Teva Pharmaceutical Industries Ltd.(Jerusalem, Israel), Ther-Rx (Bridgetown, MO), Warner Chilcott (Rockaway,NJ), and Wyeth (Madison, NJ). He has received grant/research support from BioSante (Lincolnshire, IL), Boehringer Ingelheim (Ingelheim,Germany), FemmePharma (Wayne, PA), GlaxoSmithKline (Philadelphia, PA), Nanma/Tripharma/Trinity (Glen Arm, MD), Novartis(Basel, Switzerland), Procter & Gamble (Cincinnati, OH), QuatRx Pharmaceuticals (Ann Arbor, MI), and Teva Pharmaceutical Industries Ltd. (Jerusalem, Israel). He has also served on the speakers bureaus of Amgen Inc. (Thousand Oaks, CA), Ascend Therapeutics (Herndon, VA), Bayer (Leverkusen, Germany), Boehringer Ingelheim (Ingelheim, Germany), GlaxoSmithKline (Philadelphia, PA), KV Pharmaceutical Co. (St. Louis, MO), Merck (Whitehouse Station, NJ), Novartis (Basel, Switzerland), Novogyne (East Hanover, NJ), Sciele (Atlanta, GA), Teva Pharmaceutical Industries Ltd. (Jerusalem, Israel), Ther-Rx (Bridgeton, MO), Warner Chilcott (Rockaway, NJ), and Wyeth (Madison, NJ).

Address correspondence to: Ricki Pollycove, MD, MS, NCMP FACOG, California Pacific Medical Center, 2100 Webster Street, Suite 320, San Francisco, CA 94115. E-mail:

©2011The North American Menopause Society