and dryness problems (see vaginal atrophy) while only minimally increasing the levels of estrogen in the bloodstream. in terms of managing hot flashes, lifestyle measures such as drinking cold liquids, staying in cool rooms, using fans, removing excess clothing, and avoiding hot flash triggers such as hot drinks, spicy foods, etc., may partially supplement (or even obviate) the use of medications for some women. individual counseling or support groups can sometimes be helpful to handle sad, depressed, anxious or confused feelings women may be having as they pass through what can be for some a very challenging transition time. osteoporosis can be minimized by smoking cessation, adequate vitamin d intake and regular weight-bearing exercise. the bisphosphonate drug alendronate may decrease the risk of a fracture, in women that have both bone loss and a previous fracture and less so for those with just osteoporosis. a surgical procedure where a part of one of the ovaries is removed earlier in life and frozen and then over time thawed and returned to the body has been tried. while at least 11 women have undergone the procedure and paid over £6,000, there is no evidence it is safe or effective. society and culture the cultural context within which a woman lives can have a significant impact on the way she experiences the menopausal transition. menopause has been described as a subjective experience, with social and cultural factors playing a prominent role in the way menopause is experienced and perceived. the word menopause was invented by french doctors at the beginning of the nineteenth century. some of them noted that peasant women had no complaints about the end of menses, while urban middle-class women had many troubling symptoms. doctors at this time considered the symptoms to be the result of urban lifestyles of sedentary behaviour, alcohol consumption, too much time indoors, and over-eating, with a lack of fresh fruit and vegetables. within the united states, social location affects the way women perceive menopause and its related biological effects. research indicates that whether a woman views menopause as a medical issue or an expected life change is correlated with her socio-economic status. the paradigm within which a woman considers menopause influences the way she views it: women who understand menopause as a medical condition rate it significantly more negatively than those who view it as a life transition or a symbol of aging. ethnicity and geography play roles in the experience of menopause. american women of different ethnicities report significantly different types of menopausal effects. one major study found caucasian women most likely to report what are sometimes described as psychosomatic symptoms, while african-american women were more likely to report vasomotor symptoms. it seems that japanese women experience menopause effects, or konenki, in a different way from american women. japanese women report lower rates of hot flashes and night sweats; this can be attributed to a variety of factors, both biological and social. historically, konenki was associated with wealthy middle-class housewives in japan, i.e., it was a "luxury disease" that women from traditional, inter-generational rural households did not report. menopause in japan was viewed as a symptom of the inevitable process of aging, rather than a "revolutionary transition", or a "deficiency disease" in need of management. in japanese culture, reporting of vasomotor symptoms has been on the increase, with research conducted in 2005 finding that of 140 japanese participants, hot flashes were prevalent in 22.1%. this was almost double that of 20 years prior. whilst the exact cause for this is unknown, possible contributing factors include significant dietary changes, increased medicalisation of middle-aged women and increased media attention on the subject. however, reporting of vasomotor symptoms is still significantly lower than north america. additionally, while most women in the united states apparently have a negative view of menopause as a time of deterioration or decline, some studies seem to indicate that women from some asian cultures have an understanding of menopause that focuses on a sense of liberation and celebrates the freedom from the risk of pregnancy. diverging from these conclusions, one study appeared to show that many american women "experience this time as one of liberation and self-actualization". etymology menopause literally means the "end of monthly cycles" (the end of monthly periods or menstruation), from the greek word pausis ("pause") and mēn ("month"). this is a medical coinage; the greek word for menses is actually different. in ancient greek, the menses were described in the plural, ta emmēnia ("the monthlies"), and its modern descendant has been clipped to ta emmēna. the modern greek medical term is emmenopausis in katharevousa or emmenopausi in demotic greek. the word "menopause" was coined specifically for human females, where the end of fertility is traditionally indicated by the permanent stopping of monthly menstruations. however, menopause exists in some other animals, many of which do not have monthly menstruation; in this case, the term means a natural end to fertility that occurs before the end of the natural lifespan. menopause in popular culture in recent years celebrities have spoken out about their experiences of the menopause, which has led to it becoming less of a taboo as it has boosted awareness of the debilitating symptoms. this has led to tv shows running features on the menopause to help women experiencing symptoms. in the uk lorraine kelly has been an advocate for getting women to speak about their experiences including sharing her own. this has led to an increase in women seeking treatment such as hrt evolutionary rationale few animals have a menopause: humans are joined by just four other species in which females live substantially longer than their ability to reproduce. the others are all cetaceans: beluga whales, narwhals, orcas and short-finned pilot whales. various theories have been suggested that attempt to suggest evolutionary benefits to the human species stemming from the cessation of women's reproductive capability before the end of their natural lifespan. explanations can be categorized as adaptive and non-adaptive: non-adaptive hypotheses the high cost of female investment in offspring may lead to physiological deteriorations that amplify susceptibility to becoming infertile. this hypothesis suggests the reproductive lifespan in humans has been optimized, but it has proven more difficult in females and thus their reproductive span is shorter. if this hypothesis were true, however, age at menopause should be negatively correlated with the amount of energy expended to maintain the reproductive organs, and the available data does not support this. a recent increase in female longevity due to improvements in the standard of living and social care has also been suggested. it is difficult for selection, however, to favor aid to offspring from parents and grandparents. irrespective of living standards, adaptive responses are limited by physiological mechanisms. in other words, senescence is programmed and regulated by specific genes. early human selection shadow while it is fairly common for extant hunter-gatherers to live past age 50 provided that they survive childhood, fossil evidence shows that mortality in adults has decreased over the last 30,000 to 50,000 years and that it was extremely unusual for early homo sapiens to live to age 50. this discovery has led some biologists to argue that there was no selection for or against menopause at the time at which the ancestor of all modern humans lived in africa, suggesting that menopause is instead a random evolutionary effect of a selection shadow regarding aging in early homo sapiens. it is also argued that since the population fraction of post-menopausal women in early homo sapiens was so low, menopause had no evolutionary effect on mate selection or social behaviors related to mate selection. "survival of the fittest" hypothesis this hypothesis suggests that younger mothers and offspring under their care will fare better in a difficult and predatory environment because a younger mother will be stronger and more agile in providing protection and sustenance for herself and a nursing baby. the various biological factors associated with menopause had the effect of male members of the species investing their effort with the most viable of potential female mates. a problem with this hypothesis is that, if true, we would expect to see menopause exhibited among many species in the animal kingdom, and another problem is that in the case of extended child development, even a female who was relatively young, still agile, and attractive when producing a child would lose future support from her male partner due to him seeking out fertile mates when she reaches menopause, while the child is still not independent. this would be counterproductive to the supposed adaptation of getting male support, as it would significantly decrease the survival for children produced over much of the female's fertile and agile life, unless children were raised in ways that did not rely on support from a male partner, which would eliminate the supposed evolutionary benefit anyway. young female preference hypothesis the young female preference hypothesis proposes that changes in male preferences for younger mates allowed late-age acting fertility mutations to accumulate in females without any evolutionary penalty, giving rise to menopause. a computer model was constructed to test this hypothesis, and showed that it was feasible. however, in order for deleterious mutations that affect fertility past roughly age fifty to accumulate, human maximum lifespan had to first be extended to about its present value. as of 2016 it was unclear if there has been sufficient time since that happened for such an evolutionary process to occur. male-biased philopatry hypothesis the male-biased philopatry theory proposes that if human social groups were originally based around men leaving their birth communities more frequently than women, then this leads to increased relatedness to the group in relation to female age, making inclusive fitness benefits older females receive from helping the group greater than what they would receive from continued reproduction, which in turn eventually led to the evolution of menopause. in a pattern of male-biased dispersal and local mating, the relatedness of the individuals in the group decreases with female age, leading to a decrease in kin selection with female age. this occurs because a female will stay with her father in her birth community throughout life, initially being closely related to the males and females. females are born and stay in the group, so relatedness to the females stays about the same. however, throughout time, the older male relatives will die and any sons she gives birth to will disperse, so that local relatedness to males, and therefore the whole group, declines. the situation is reversed in species where males are philopatric and either females disperse, or mating is non-local. under these conditions, a female's reproductive life begins away from her father and paternal relatives because she was either born into a new group from non-local mating or because she dispersed. in the case of female-biased dispersal, the female is initially equally unrelated with every individual in the group, and with non-local mating, the female is closely related to the females of the group, but not the males since her paternal relatives are in another group. as she gives birth, her sons will stay with her, increasing her relatedness to males in the group over time and thus her relatedness with the overall group. the common feature that connects these two otherwise different behaviors is male-biased philopatry, which leads to an increase in kin selection with female age. while not conclusive, evidence does exist to support the idea that female-biased dispersal existed in pre-modern humans. the closest living relatives to humans, chimpanzees, bonobos, and both mountain gorillas and western lowland gorillas, are female-biased dispersers. analysis of sex specific genetic material, the non-recombining portions of the y chromosome and mitochondrial dna, show evidence of a prevalence of female-biased dispersal as well; however, these results could also be affected by the effective breeding numbers of males and females in local populations. evidence of female-biased dispersion in hunter-gatherers is not definitive, with some studies supporting the idea, and others suggesting there is no strong bias towards either sex. in orcas, both sexes mate non-locally with members of a different pod but return to the pod after copulation. demographic data shows that a female's mean relatedness to the group does increase over time due to increasing relatedness to males. while less well-studied, there is evidence that short-finned pilot whales, another menopausal