text:
English grammar

English grammar is the set of structural rules of the English language. This includes the structure of words, phrases, clauses, sentences, and whole texts.

This article describes a generalized, present-day Standard English – a form of speech and writing used in public discourse, including broadcasting, education, entertainment, government, and news, over a range of registers, from formal to informal. Divergences from the grammar described here occur in some historical, social, cultural, and regional varieties of English, although these are minor than differences in pronunciation and vocabulary.

Modern English has largely abandoned the inflectional case system of Indo-European in favor of analytic constructions. The personal pronouns retain morphological case more strongly than any other word class (a remnant of the more extensive Germanic case system of Old English). For other pronouns, and all nouns, adjectives, and articles, grammatical function is indicated only by word order, by prepositions, and by the "Saxon genitive or English possessive" (-'s).

Eight "word classes" or "parts of speech" are commonly distinguished in English: nouns, determiners, pronouns, verbs, adjectives, adverbs, prepositions, and conjunctions. Nouns form the largest word class, and verbs the second-largest. Unlike nouns in many other Indo-European languages, English nouns do not have grammatical gender.

Word classes and phrases
Noun, verb, adjective, and adverb forms are called open classes – word classes that readily accept new members, such as the noun celebutante (a celebrity who frequents the fashion circles), and other similar relatively new words. The rest are considered to be closed classes. For example, it is rare for a new pronoun to enter the language. Determiners, traditionally classified along with adjectives, have not always been regarded as a separate part of speech. Interjections are another word class, but these are not described here as they do not form part of the clause and sentence structure of the language.

Linguists generally accept nine English word classes: nouns, verbs, adjectives, adverbs, pronouns, prepositions, conjunctions, determiners, and exclamations. English words are not generally marked for word class. It is not usually possible to tell from the form of a word which class it belongs to except, to some extent, in the case of words with inflectional endings or derivational suffixes. On the other hand, most words belong to more than one-word class. For example, run can serve as either a verb or a noun (these are regarded as two different lexemes). Lexemes may be inflected to express different grammatical categories. The lexeme run has the forms runs, ran, runny, runner, and running. Words in one class can sometimes be derived from those in another. This has the potential to give rise to new words. For example, the noun aerobics has given rise to the adjective aerobicized.

Words combine to form phrases. A phrase typically serves the same function as a word from some particular word class. For example, my very good friend Peter is a phrase that can be used in a sentence as if it were a noun, and is therefore called a noun phrase. Similarly, adjectival phrases and adverbial phrases function as if they were adjectives or adverbs, but with other types of phrases, the terminology has different implications. For example, a verb phrase consists of a verb together with any objects and other dependents; a prepositional phrase consists of a preposition and its complement (and is therefore usually a type of adverbial phrase); and a determiner phrase is a type of noun phrase containing a determiner.

Nouns
Many common suffixes form nouns from other nouns or from other types of words, such as -age (shrinkage), -hood (sisterhood), and so on, though many nouns are base forms containing no such suffix (cat, grass, France). Nouns are also created by converting verbs and adjectives, as with the words talk and reading (a boring talk, the assigned reading).

Nouns are sometimes classified semantically (by their meanings) as proper and common nouns (Cyrus, China vs frog, milk) or as concrete and abstract nouns (book, laptop vs embarrassment, prejudice). A grammatical distinction is often made between count (countable) nouns such as clock and city, and non-count (uncountable) nouns such as milk and decor. Some nouns can function both as countable and as uncountable such as "wine" in This is a good wine.

Countable nouns generally have singular and plural forms. In most cases the plural is formed from the singular by adding -[e]s (as in dogs, bushes), although there are also irregular forms (woman/women, foot/feet), including cases where the two forms are identical (sheep, series). For more details see English plural. Certain nouns can be used with plural verbs even though they are singular in form, as in The government were ... (where the government is considered to refer to the people constituting the government). This is a form of synesis, and is more common in British than American English. See.

English nouns are not marked for case as they are in some languages, but they have possessive forms, through the addition of -'s (as in John's, children's) or just an apostrophe (with no change in pronunciation) in the case of -[e]s plurals (the dogs' owners) and sometimes other words ending with -s (Jesus' love). More generally the ending can be applied to noun phrases (as in the man you saw yesterday's sister); see below. The possessive form can be used either as a determiner (Manyanda's cat) or as a noun phrase (Manyanda's is the one next to Jane's).

The status of the possessive as an affix or a clitic is the subject of debate. It differs from the noun inflection of languages such as German, in that the genitive ending may attach to the last word of the phrase. To account for this, the possessive can be analysed, for instance as a clitic construction (an "enclitic postposition" ) or as an inflection of the last word of a phrase ("edge inflection").

Phrases
Noun phrases are phrases that function grammatically as nouns within sentences, for example as the subject or object of a verb. Most noun phrases have a noun as their head.

An English noun phrase typically takes the following form (not all elements need be present):
 * {| cellspacing="5"

! Determiner || + || Pre-modifiers || + || NOUN || + || Postmodifiers/Complement
 * - style="font-variant: small-caps; font-size: larger;"
 * }

In this structure:
 * the determiner may be an article (the, a[n]) or other equivalent word, as described in the following section. In many contexts, it is required for a noun phrase to include some determiner.
 * pre-modifiers include adjectives and some adjective phrases (such as red, really lovely), and noun adjuncts (such as college in the phrase the college student). Adjectival modifiers usually come before noun adjuncts.
 * a complement or postmodifier may be a prepositional phrase (... of London), a relative clause (like ...which we saw yesterday), certain adjective or participial phrases (... sitting on the beach), or a dependent clause or infinitive phrase appropriate to the noun (like ... that the world is round after a noun such as fact or statement, or ... to travel widely after a noun such as desire).

An example of a noun phrase that includes all of the above-mentioned elements is that rather attractive young college student to whom you were talking. Here that is the determiner, rather attractive and young are adjectival pre-modifiers, college is a noun adjunct, student is the noun serving as the head of the phrase, and to whom you were talking is a post-modifier (a relative clause in this case). Notice the order of the pre-modifiers; the determiner that must come first and the noun adjunct college must come after the adjectival modifiers.

Coordinators such as and, or, and but can be used at various levels in noun phrases, as in John, Paul, and Mary; the matching green coat and hat; a dangerous but exciting ride; a person sitting down or standing up. See below for more explanation.

Noun phrases can also be placed in apposition (where two consecutive phrases refer to the same thing), as in that president, Abraham Lincoln, ... (where that president and Abraham Lincoln are in apposition). In some contexts, the same can be expressed by a prepositional phrase, as in the twin curses of famine and pestilence (meaning "the twin curses" that are "famine and pestilence").

Particular forms of noun phrases include:
 * phrases formed by the determiner the with an adjective, as in the homeless, the English (these are plural phrases referring to homeless people or English people in general);
 * phrases with a pronoun rather than a noun as the head (see below);
 * phrases consisting just of a possessive;
 * infinitive and gerund phrases, in certain positions;
 * certain clauses, such as that clauses and relative clauses like what he said, in certain positions.

Gender
A system of grammatical gender, whereby every noun was treated as either masculine, feminine, or neuter, existed in Old English, but fell out of use during the Middle English period. Modern English retains features relating to natural gender, most prominently the use of pronouns (such as he and she) to refer specifically to persons or animals of one or other genders and certain others (such as it) for sexless objects – although feminine pronouns are sometimes used when referring to ships (and more uncommonly some airplanes and analogous machinery) and nation-states.

Some aspects of gender usage in English have been influenced by the movement towards a preference for gender-neutral language. Animals are triple-gender nouns, being able to take masculine, feminine and neuter pronouns. While the vast majority of nouns in English do not carry gender, there remain some gendered nouns (e.g. ewe, sow, rooster) and derivational affixes (e.g. widower, waitress) that denote gender.

Many nouns that mention people's roles and jobs can refer to either a masculine or a feminine subject, for instance "cousin", "teenager", "teacher", "doctor", "student", "friend", and "colleague".

 * Jane is my friend. She is a dentist.
 * Paul is my cousin. He is a dentist.

Often the gender distinction for these neutral nouns is established by inserting the word "male" or "female".

 * Sam is a male nurse.
 * No, he is not my boyfriend; he is just a male friend.
 * I have three female cousins and two male cousins.

Rarely, nouns illustrating things with no gender are referred to with a gendered pronoun to convey familiarity. It is also standard to use the gender-neutral pronoun (it).

 * I love my car. She [the car] is my greatest passion.
 * France is popular with her [France's] neighbors at the moment.
 * I traveled from England to New York on the Queen Elizabeth; she [the Queen Elizabeth] is a great ship.

Determiners
English determiners constitute a relatively small class of words. They include the articles the and a[n]; certain demonstrative and interrogative words such as this, that, and which; possessives such as my and whose (the role of determiner can also be played by noun possessive forms such as John's and the girl's); various quantifying words like all, some, many, various; and numerals (one, two, etc.). There are also many phrases (such as a couple of) that can play the role of determiners.

Determiners are used in the formation of noun phrases (see above). Many words that serve as determiners can also be used as pronouns (this, that, many, etc.).

Determiners can be used in certain combinations, such as all the water and the many problems.

In many contexts, it is required for a noun phrase to be completed with an article or some other determiner. It is not grammatical to say just cat sat on table; one must say my cat sat on the table. The most common situations in which a complete noun phrase can be formed without a determiner are when it refers generally to a whole class or concept (as in dogs are dangerous and beauty is subjective) and when it is a name (Jane, Spain, etc.). This is discussed in more detail at English articles and Zero article in English.

Pronouns
Pronouns are a relatively small, closed class of words that function in the place of nouns or noun phrases. They include personal pronouns, demonstrative pronouns, relative pronouns, interrogative pronouns, and some others, mainly indefinite pronouns. The full set of English pronouns is presented in the following table. Nonstandard, informal and archaic forms are in italics. † Interrogative only.

Personal
The personal pronouns of modern standard English are presented in the table above. They are I, you, she, he, it, we, and they. The personal pronouns are so-called not because they apply to persons (which other pronouns also do), but because they participate in the system of grammatical person (1st, 2nd, 3rd).

The second-person forms such as you are used with both singular and plural reference. In the Southern United States, y'all (you all) is used as a plural form, and various other phrases such as you guys are used in other places. An archaic set of second-person pronouns used for singular reference is thou, thee, thyself, thy, thine, which are still used in religious services and can be seen in older works, such as Shakespeare's—in such texts, the you set of pronouns are used for plural reference, or with singular reference as a formal V-form. You can also be used as an indefinite pronoun, referring to a person in general (see generic you), compared to the more formal alternative, one (reflexive oneself, possessive one's).

The third-person singular forms are differentiated according to the gender of the referent. For example, she is used to refer to a woman, sometimes a female animal, and sometimes an object to which feminine characteristics are attributed, such as a ship or a country. A man, and sometimes a male animal, is referred to using he. In other cases, it can be used. (See Gender in English.) The word it can also be used as a dummy subject, concerning abstract ideas like time, weather, etc.

The third-person form they is used with both plural and singular referents. Historically, singular they was restricted to quantificational constructions such as Each employee should clean their desk and referential cases where the referent's gender was unknown. However, it is increasingly used when the referent's gender is irrelevant or when the referent is neither male nor female.

The possessive determiners such as my are used as determiners together with nouns, as in my old man, some of his friends. The second possessive forms like mine are used when they do not qualify a noun: as pronouns, as in mine is bigger than yours, and as predicates, as in this one is mine. Note also the construction a friend of mine (meaning "someone who is my friend"). See English possessive for more details.

Demonstrative
The demonstrative pronouns of English are this (plural these), and that (plural those), as in these are good, I like that. All four words can also be used as determiners (followed by a noun), as in those cars. They can also form the alternative pronominal expressions this/that one, these/those ones.

Interrogative
The interrogative pronouns are who, what, and which (all of them can take the suffix -ever for emphasis). The pronoun who refers to a person or people; it has an oblique form whom (though in informal contexts this is usually replaced by who), and a possessive form (pronoun or determiner) whose. The pronoun what refers to things or abstracts. The word which is used to ask about alternatives from what is seen as a closed set: which (of the books) do you like best? (It can also be an interrogative determiner: which book?; this can form the alternative pronominal expressions which one and which ones.) Which, who, and what can be either singular or plural, although who and what often take a singular verb regardless of any supposed number. For more information see who.

In Old and Middle English, the roles of the three words were different from their roles today. "The interrogative pronoun hwā 'who, what' had only singular forms and also only distinguished between non-neuter and neuter, the neuter nominative form being hwæt." Note that neuter and non-neuter refers to the grammatical gender system of the time, rather than the so-called natural gender system of today. A small holdover of this is the ability of relative (but not interrogative) whose to refer to non-persons (e.g., the car whose door won't open).

All the interrogative pronouns can also be used as relative pronouns, though what is quite limited in its use; see below for more details.

Relative
The main relative pronouns in English are who (with its derived forms whom and whose), which, and that.

The relative pronoun which refers to things rather than persons, as in the shirt, which used to be red, is faded. For persons, who is used (the man who saw me was tall). The oblique case form of who is whom, as in the man whom I saw was tall, although in informal registers who is commonly used in place of whom.

The possessive form of who is whose (for example, the man whose car is missing); however the use of whose is not restricted to persons (one can say an idea whose time has come).

The word that as a relative pronoun is normally found only in restrictive relative clauses (unlike which and who, which can be used in both restrictive and unrestrictive clauses). It can refer to either persons or things, and cannot follow a preposition. For example, one can say the song that [or which] I listened to yesterday, but the song to which [not to that] I listened yesterday. The relative pronoun that is usually pronounced with a reduced vowel (schwa), and hence differently from the demonstrative that (see Weak and strong forms in English). If that is not the subject of the relative clause, it can be omitted (the song I listened to yesterday).

The word what can be used to form a free relative clause – one that has no antecedent and that serves as a complete noun phrase in itself, as in I like what he likes. The words whatever and whichever can be used similarly, in the role of either pronouns (whatever he likes) or determiners (whatever book he likes). When referring to persons, who(ever) (and whom(ever)) can be used in a similar way.

"There"
The word there is used as a pronoun in some sentences, playing the role of a dummy subject, normally of an intransitive verb. The "logical subject" of the verb then appears as a complement after the verb.

This use of there occurs most commonly with forms of the verb be in existential clauses, to refer to the presence or existence of something. For example: There is a heaven; There are two cups on the table; There have been a lot of problems lately. It can also be used with other verbs: There exist two major variants; There occurred a very strange incident.

The dummy subject takes the number (singular or plural) of the logical subject (complement), hence it takes a plural verb if the complement is plural. In informal English, however, the contraction there's is often used for both singular and plural.

The dummy subject can undergo inversion, Is there a test today? and Never has there been a man such as this. It can also appear without a corresponding logical subject, in short sentences and question tags: ''There wasn't a discussion, was there? There was.''

The word there in such sentences has sometimes been analyzed as an adverb, or as a dummy predicate, rather than as a pronoun. However, its identification as a pronoun is most consistent with its behavior in inverted sentences and question tags as described above.

Because the word there can also be a deictic adverb (meaning "at/to that place"), a sentence like There is a river could have either of two meanings: "a river exists" (with there as a pronoun), and "a river is in that place" (with there as an adverb). In speech, the adverbial there would be given stress, while the pronoun would not – in fact, the pronoun is often pronounced as a weak form,.

Reciprocal
The English reciprocal pronouns are each other and one another. Although they are written with a space, they're best thought of as single words. No consistent distinction in meaning or use can be found between them. Like the reflexive pronouns, their use is limited to contexts where an antecedent precedes it. In the case of the reciprocals, they need to appear in the same clause as the antecedent.

Other
Other pronouns in English are often identical in form to determiners (especially quantifiers), such as many, a little, etc. Sometimes, the pronoun form is different, as with none (corresponding to the determiner no), nothing, everyone, somebody, etc. Many examples are listed as indefinite pronouns. Another indefinite (or impersonal) pronoun is one (with its reflexive form oneself and possessive one's), which is a more formal alternative to generic you.

Verbs
The basic form of an English verb is not generally marked by any ending, although there are certain suffixes that are frequently used to form verbs, such as -ate (formulate), -fy (electrify), and -ise/ize (realise/realize). Many verbs also contain prefixes, such as un- (unmask), out- (outlast), over- (overtake), and under- (undervalue). Verbs can also be formed from nouns and adjectives by zero derivation, as with the verbs snare, nose, dry, and calm.

Most verbs have three or four inflected forms in addition to the base form: a third-person singular present tense form in -(e)s (writes, botches), a present participle and gerund form in -ing (writing), a past tense (wrote), and – though often identical to the past tense form – a past participle (written). Regular verbs have identical past tense and past participle forms in -ed, but there are 100 or so irregular English verbs with different forms (see list). The verbs have, do and say also have irregular third-person present tense forms (has, does, says ). The verb be has the largest number of irregular forms (am, is, are in the present tense, was, were in the past tense, been for the past participle).

Most of what are often referred to as verb tenses (or sometimes aspects) in English are formed using auxiliary verbs. Apart from what are called the simple present (write, writes) and simple past (wrote), there are also continuous (progressive) forms (am/is/are/was/were writing), perfect forms (have/has/had written, and the perfect continuous have/has/had been writing), future forms (will write, will be writing, will have written, will have been writing), and conditionals (also called "future in the past"), so forms equivalent to future ones but with would instead of will. The auxiliaries shall and should sometimes replace will and would in the first person. For the uses of these various verb forms, see English verbs and English clause syntax.

The basic form of the verb (be, write, play) is used as the infinitive, although there is also a "to-infinitive" (to be, to write, to play) used in many syntactical constructions. There are also infinitives corresponding to other aspects: (to) have written, (to) be writing, (to) have been writing. The second-person imperative is identical to the (basic) infinitive; other imperative forms may be made with let (let us go, or let's go; let them eat cake).

A form identical to the infinitive can be used as a present subjunctive in certain contexts: It is important that he follow them or ... that he be committed to the cause. There is also a past subjunctive (distinct from the simple past only in the possible use of were instead of was), used in some conditional sentences and similar: if I were (or was) rich ...; were he to arrive now ...; I wish she were (or was) here. For details see English subjunctive.

The passive voice is formed using the verb be (in the appropriate tense or form) with the past participle of the verb in question: cars are driven, he was killed, I am being tickled, it is nice to be pampered, etc. The performer of the action may be introduced in a prepositional phrase with by (as in they were killed by the invaders).

The English modal verbs consist of the core modals can, could, may, might, must, shall, should, will, would, as well as ought (to), had better, and in some uses dare and need. These do not inflect for person or number, do not occur alone, and do not have infinitive or participle forms (except synonyms, as with be/being/been able (to) for the modals can/could). The modals are used with the basic infinitive form of a verb (I can swim, he may be killed, we dare not move, need they go?), except for ought, which takes to (you ought to go). Modals can indicate the condition, probability, possibility, necessity, obligation and ability exposed by the speaker's or writer's attitude or expression.

The copula be, along with the modal verbs and the other auxiliaries, form a distinct class, sometimes called "special verbs" or simply "auxiliaries". These have different syntax from ordinary lexical verbs, especially in that they make their interrogative forms by plain inversion with the subject, and their negative forms by adding not after the verb (could I ...? I could not ...). Apart from those already mentioned, this class may also include used to (although the forms did he use to? and he didn't use to are also found), and sometimes have even when not an auxiliary (forms like have you a sister? and he hadn't a clue are possible, though becoming less common). It also includes the auxiliary do (does, did); this is used with the basic infinitive of other verbs (those not belonging to the "special verbs" class) to make their question and negation forms, as well as emphatic forms (do I like you?; he doesn't speak English; we did close the fridge). For more details of this, see do-support.

Some forms of the copula and auxiliaries often appear as contractions, as in I'm for I am, you'd for you would or you had, and John's for John is. Their negated forms with following not are also often contracted (see below). For detail see English auxiliaries and contractions.

Phrases
A verb together with its dependents, excluding its subject, may be identified as a verb phrase (although this concept is not acknowledged in all theories of grammar ). A verb phrase headed by a finite verb may also be called a predicate. The dependents may be objects, complements, and modifiers (adverbs or adverbial phrases). In English, objects and complements nearly always come after the verb; a direct object precedes other complements such as prepositional phrases, but if there is an indirect object as well, expressed without a preposition, then that precedes the direct object: give me the book, but give the book to me. Adverbial modifiers generally follow objects, although other positions are possible (see under below). Certain verb–modifier combinations, particularly when they have independent meaning (such as take on and get up), are known as "phrasal verbs".

For details of possible patterns, see English clause syntax. See the Non-finite clauses section of that article for verb phrases headed by non-finite verb forms, such as infinitives and participles.

Adjectives
English adjectives, as with other word classes, cannot in general be identified as such by their form, although many of them are formed from nouns or other words by the addition of a suffix, such as -al (habitual), -ful (blissful), -ic (atomic), -ish (impish, youngish), -ous (hazardous), etc.; or from other adjectives using a prefix: disloyal, irredeemable, unforeseen, overtired.

Adjectives may be used attributively, as part of a noun phrase (nearly always preceding the noun they modify; for exceptions see postpositive adjective), as in the big house, or predicatively, as in the house is big. Certain adjectives are restricted to one or other use; for example, drunken is attributive (a drunken sailor), while drunk is usually predicative (the sailor was drunk).

Comparison
Many adjectives have comparative and superlative forms in -er and -est, such as faster and fastest (from the positive form fast). Spelling rules which maintain pronunciation apply to suffixing adjectives just as they do for similar treatment of regular past tense formation; these cover consonant doubling (as in bigger and biggest, from big) and the change of y to i after consonants (as in happier and happiest, from happy).

The adjectives good and bad have the irregular forms better, best and worse, worst; also far becomes farther, farthest or further, furthest. The adjective old (for which the regular older and oldest are usual) also has the irregular forms elder and eldest, these generally being restricted to use in comparing siblings and in certain independent uses. For the comparison of adverbs, see Adverbs below.

Many adjectives, however, particularly those that are longer and less common, do not have inflected comparative and superlative forms. Instead, they can be qualified with more and most, as in beautiful, more beautiful, most beautiful (this construction is also sometimes used even for adjectives for which inflected forms do exist).

Certain adjectives are classed as ungradable. These represent properties that cannot be compared on a scale; they simply apply or do not, as with pregnant, dead, unique. Consequently, comparative and superlative forms of such adjectives are not normally used, except in a figurative, humorous or imprecise context. Similarly, such adjectives are not normally qualified with modifiers of degree such as very and fairly, although with some of them it is idiomatic to use adverbs such as completely. Another type of adjective sometimes considered ungradable is those that represent an extreme degree of some property, such as delicious and terrified.

Phrases
An adjective phrase is a group of words that plays the role of an adjective in a sentence. It usually has a single adjective as its head, to which modifiers and complements may be added.

Adjectives can be modified by a preceding adverb or adverb phrase, as in very warm, truly imposing, more than a little excited. Some can also be preceded by a noun or quantitative phrase, as in fat-free, two-meter-long.

Complements following the adjective may include:
 * prepositional phrases: proud of him, angry at the screen, keen on breeding toads;
 * infinitive phrases: anxious to solve the problem, easy to pick up;
 * content clauses, i.e. that clauses and certain others: certain that he was right, unsure where they are;
 * after comparatives, phrases or clauses with than: better than you, smaller than I had imagined.

An adjective phrase may include both modifiers before the adjective and a complement after it, as in very difficult to put away.

Adjective phrases containing complements after the adjective cannot normally be used as attributive adjectives before a noun. Sometimes they are used attributively after the noun, as in a woman proud of being a midwife (where they may be converted into relative clauses: a woman who is proud of being a midwife), but it is wrong to say *a proud of being a midwife woman. Exceptions include very brief and often established phrases such as easy-to-use. (Certain complements can be moved to after the noun, leaving the adjective before the noun, as in a better man than you, a hard nut to crack.)

Certain attributive adjective phrases are formed from other parts of speech, without any adjective as their head, as in a two-bedroom house, a no-jeans policy.

Adverbs
Adverbs perform a wide range of functions. They typically modify verbs (or verb phrases), adjectives (or adjectival phrases), or other adverbs (or adverbial phrases). However, adverbs also sometimes qualify noun phrases (only the boss; quite a lovely place), pronouns and determiners (almost all), prepositional phrases (halfway through the movie), or whole sentences, to provide contextual comment or indicate an attitude (Frankly, I don't believe you). They can also indicate a relationship between clauses or sentences (He died, and consequently I inherited the estate).

Many English adverbs are formed from adjectives by adding the ending -ly, as in hopefully, widely, theoretically (for details of spelling and etymology, see -ly). Certain words can be used as both adjectives and adverbs, such as fast, straight, and hard; these are flat adverbs. In earlier usage more flat adverbs were accepted in formal usage; many of these survive in idioms and colloquially. (That's just plain ugly.) Some adjectives can also be used as flat adverbs when they actually describe the subject. (The streaker ran naked, not The streaker ran nakedly.) The adverb corresponding to the adjective good is well (note that bad forms the regular badly, although ill is occasionally used in some phrases).

There are also many adverbs that are not derived from adjectives, including adverbs of time, of frequency, of place, of degree and with other meanings. Some suffixes that are commonly used to form adverbs from nouns are -ward[s] (as in homeward[s]) and -wise (as in lengthwise).

Adverbs are also formed by adding ly to the participles. For example, according, a present participle adjective, becomes accordingly, an adverb, by adding ly after it. The past participle adjective repeated becomes repeatedly by adding ly after it.

Most adverbs form comparatives and superlatives by modification with more and most: often, more often, most often; smoothly, more smoothly, most smoothly (see also comparison of adjectives, above). However, a few adverbs retain irregular inflection for comparative and superlative forms: much, more, most; a little, less, least; well, better, best; badly, worse, worst; far, further (farther), furthest (farthest); or follow the regular adjectival inflection: fast, faster, fastest; soon, sooner, soonest; etc.

Adverbs indicating the manner of an action are generally placed after the verb and its objects (We considered the proposal carefully), although other positions are often possible (We carefully considered the proposal). Many adverbs of frequency, degree, certainty, etc. (such as often, always, almost, probably, and various others such as just) tend to be placed before the verb (they usually have chips), although if there is an auxiliary or other "special verb" (see above), then the normal position for such adverbs is after that special verb (or after the first of them, if there is more than one): I have just finished the crossword; She can usually manage a pint; We are never late; You might possibly have been unconscious. Adverbs that provide a connection with previous information (such as next, then, however), and those that provide the context (such as time or place) for a sentence, are typically placed at the start of the sentence: Yesterday we went on a shopping expedition. If the verb has an object, the adverb comes after the object (He finished the test quickly). When there is more than one types of adverb, they usually appear in the order: manner, place, time (His arm was hurt severely at home yesterday).

A special type of adverb is the adverbial particle used to form phrasal verbs (such as up in pick up, on in get on, etc.) If such a verb also has an object, then the particle may precede or follow the object, although it will normally follow the object if the object is a pronoun (pick the pen up or pick up the pen, but pick it up).

Phrases
An adverb phrase is a phrase that acts as an adverb within a sentence. An adverb phrase may have an adverb as its head, together with any modifiers (other adverbs or adverb phrases) and complements, analogously to the adjective phrases described above. For example: very sleepily; all too suddenly; oddly enough; perhaps shockingly for us.

Another very common type of adverb phrase is the prepositional phrase, which consists of a preposition and its object: in the pool; after two years; for the sake of harmony.

Prepositions
Prepositions form a closed word class, although there are also certain phrases that serve as prepositions, such as in front of. A single preposition may have a variety of meanings, often including temporal, spatial and abstract. Many words that are prepositions can also serve as adverbs. Examples of common English prepositions (including phrasal instances) are of, in, on, over, under, to, from, with, in front of, behind, opposite, by, before, after, during, through, in spite of or despite, between, among, etc.

A preposition is usually used with a noun phrase as its complement. A preposition together with its complement is called a prepositional phrase. Examples are in England, under the table, after six pleasant weeks, between the land and the sea. A prepositional phrase can be used as a complement or post-modifier of a noun in a noun phrase, as in the man in the car, the start of the fight; as a complement of a verb or adjective, as in deal with the problem, proud of oneself; or generally as an adverb phrase (see above).

English allows the use of "stranded" prepositions. This can occur in interrogative and relative clauses, where the interrogative or relative pronoun that is the preposition's complement is moved to the start (fronted), leaving the preposition in place. This kind of structure is avoided in some kinds of formal English. For example: Notice that in the second example the relative pronoun that could be omitted.
 * What are you talking about? (Possible alternative version: About what are you talking?)
 * The song that you were listening to ... (more formal: The song to which you were listening ...)

Stranded prepositions can also arise in passive voice constructions and other uses of passive past participial phrases, where the complement in a prepositional phrase can become zero in the same way that a verb's direct object would: it was looked at; I will be operated on; get your teeth seen to. The same can happen in certain uses of infinitive phrases: he is nice to talk to; this is the page to make copies of.

Conjunctions
Conjunctions express a variety of logical relations between items, phrases, clauses and sentences. The principal coordinating conjunctions in English are: and, or, but, nor, so, yet, and for. These can be used in many grammatical contexts to link two or more items of equal grammatical status, for example:
 * Noun phrases combined into a longer noun phrase, such as John, Eric, and Jill, the red coat or the blue one. When and is used, the resulting noun phrase is plural. A determiner does not need to be repeated with the individual elements: the cat, the dog, and the mouse and the cat, dog, and mouse are both correct. The same applies to other modifiers. (The word but can be used here in the sense of "except": nobody but you.)
 * Adjective or adverb phrases combined into a longer adjective or adverb phrase: tired but happy, over the fields and far away.
 * Verbs or verb phrases combined as in he washed, peeled, and diced the turnips (verbs conjoined, object shared); he washed the turnips, peeled them, and diced them (full verb phrases, including objects, conjoined).
 * Other equivalent items linked, such as prefixes linked in pre- and post-test counselling, numerals as in two or three buildings, etc.
 * Clauses or sentences linked, as in We came, but they wouldn't let us in. They wouldn't let us in, nor would they explain what we had done wrong.

There are also correlative conjunctions, where as well as the basic conjunction, an additional element appears before the first of the items being linked. The common correlatives in English are:
 * either ... or (either a man or a woman);
 * neither ... nor (neither clever nor funny);
 * both ... and (they both punished and rewarded them);
 * not ... but, particularly in not only ... but also (not exhausted but exhilarated, not only football but also many other sports).

Subordinators make relations between clauses, making the clause in which they appear into a subordinate clause. Some common subordinators in English are:
 * conjunctions of time, including after, before, since, until, when, while;
 * conjunctions of cause and effect, including because, since, now that, as, in order that, so;
 * conjunctions of opposition or concession, such as although, though, even though, whereas, while;
 * conjunctions of condition: such as if, unless, only if, whether or not, even if, in case (that);
 * the conjunction that, which produces content clauses, as well as words that produce interrogative content clauses: whether, where, when, how, etc.

Subordinating conjunction generally comes at the very start of its clause, although many of them can be preceded by qualifying adverbs, as in probably because ..., especially if .... The conjunction that can be omitted after certain verbs, as in she told us (that) she was ready. (For the use of that in relative clauses, see above.)

Case
Although English has largely lost its case system, personal pronouns still have three morphological cases that are simplified forms of the nominative, objective and genitive cases:

 * The nominative case (subjective pronouns such as I, he, she, we, they, who, whoever), used for the subject of a finite verb and sometimes for the complement of a copula.
 * The oblique case (object pronouns such as me, him, her, us, it, us, them, whom, whomever), used for the direct or indirect object of a verb, for the object of a preposition, for an absolute disjunct, and sometimes for the complement of a copula.
 * The genitive case (possessive pronouns such as my/mine, his, her(s), our(s), its, our(s), their, theirs, whose), used for a grammatical possessor. This is not always considered to be a case; see.
 * The privative case (formed with the suffix -less), used for expressing the absence or lack of the marked noun, such as in the phrase the homeless man.
 * The semblative case (formed with the suffix -like), used for denoting the similarity of one noun to another, such as in the newspaper headline Texas Man Catches Fish With Human-Like Teeth.

Most English personal pronouns have five forms: the nominative and oblique case forms, the possessive case, which has both a determiner form (such as my, our) and a distinct independent form (such as mine, ours) (with two exceptions: the third person singular masculine and the third person singular neuter it, which use the same form for both determiner and independent [his car, it is his]), and a distinct reflexive or intensive form (such as myself, ourselves). The interrogative personal pronoun who exhibits the greatest diversity of forms within the modern English pronoun system, having definite nominative, oblique, and genitive forms (who, whom, whose) and equivalently coordinating indefinite forms (whoever, whomever, and whosever).

Forms such as I, he, and we are used for the subject ("I kicked the ball"), whereas forms such as me, him and us are used for the object ("John kicked me").

Declension
Nouns have distinct singular and plural forms; that is, they decline to reflect their grammatical number; consider the difference between book and books. In addition, a few English pronouns have distinct nominative (also called subjective) and oblique (or objective) forms; that is, they decline to reflect their relationship to a verb or preposition, or case. Consider the difference between he (subjective) and him (objective), as in "He saw it" and "It saw him"; similarly, consider who, which is subjective, and the objective whom. Further, these pronouns and a few others have distinct possessive forms, such as his and whose. By contrast, nouns have no distinct nominative and objective forms, the two being merged into a single plain case. For example, chair does not change form between "the chair is here" (subject) and "I saw the chair" (direct object). Possession is shown by the clitic -'s attached to a possessive noun phrase, rather than by declension of the noun itself.

Negation
As noted above under, a finite indicative verb (or its clause) is negated by placing the word not after an auxiliary, modal or other "special" verb such as do, can or be. For example, the clause I go is negated with the appearance of the auxiliary do, as I do not go (see do-support). When the affirmative already uses auxiliary verbs (I am going), no other auxiliary verbs are added to negate the clause (I am not going). (Until the period of early Modern English, negation was effected without additional auxiliary verbs: I go not.)

Most combinations of auxiliary verbs etc. with not have contracted forms: don't, can't, isn't, etc. (Also the uncontracted negated form of can is written as a single word cannot.) On the inversion of subject and verb (such as in questions; see below), the subject may be placed after a contracted negated form: Should he not pay? or Shouldn't he pay?

Other elements, such as noun phrases, adjectives, adverbs, infinitive and participial phrases, etc., can be negated by placing the word not before them: not the right answer, not interesting, not to enter, not noticing the train, etc.

When other negating words such as never, nobody, etc. appear in a sentence, the negating not is omitted (unlike its equivalents in many languages): I saw nothing or I didn't see anything, but not (except in non-standard speech) *I didn't see nothing (see Double negative). Such negating words generally have corresponding negative polarity items (ever for never, anybody for nobody, etc.) which can appear in a negative context but are not negative themselves (and can thus be used after a negation without giving rise to double negatives).

Clause and sentence structure
A typical sentence contains one independent clause and possibly one or more dependent clauses, although it is also possible to link together sentences of this form into longer sentences, using coordinating conjunctions (see above). A clause typically contains a subject (a noun phrase) and a predicate (a verb phrase in the terminology used above; that is, a verb together with its objects and complements). A dependent clause also normally contains a subordinating conjunction (or in the case of relative clauses, a relative pronoun, or phrase containing one).

Word order
English word order has moved from the Germanic verb-second (V2) word order to being almost exclusively subject–verb–object (SVO). The combination of SVO order and use of auxiliary verbs often creates clusters of two or more verbs at the center of the sentence, such as he had hoped to try to open it. In most sentences, English marks grammatical relations only through word order. The subject constituent precedes the verb and the object constituent follows it. The Object–subject–verb (OSV) may on occasion be seen in English, usually in the future tense or used as a contrast with the conjunction "but", such as in the following examples: "Rome I shall see!", "I hate oranges, but apples I'll eat!".

Questions
Like many other Western European languages, English historically allowed questions to be formed by inverting the positions of the verb and subject. Modern English permits this only in the case of a small class of verbs ("special verbs"), consisting of auxiliaries as well as forms of the copula be (see subject–auxiliary inversion). To form a question from a sentence which does not have such an auxiliary or copula present, the auxiliary verb do (does, did) needs to be inserted, along with inversion of the word order, to form a question (see do-support). For example:
 * She can dance. → Can she dance? (inversion of subject she and auxiliary can)
 * I am sitting here. → Am I sitting here? (inversion of subject I and copula am)
 * The milk goes in the fridge. → Does the milk go in the fridge? (no special verb present; do-support required)

The above concerns yes–no questions, but inversion also takes place in the same way after other questions, formed with interrogative words such as where, what, how, etc. An exception applies when the interrogative word is the subject or part of the subject, in which case there is no inversion. For example:
 * I go. → Where do I go? (wh-question formed using inversion, with do-support required in this case)
 * He goes. → Who goes? (no inversion, because the question word who is the subject)

Inversion does not apply in indirect questions: I wonder where he is (not *... where is he). Indirect yes–no questions can be expressed using if or whether as the interrogative word: Ask them whether/if they saw him.

Negative questions are formed similarly; however, if the verb undergoing inversion has a contraction with not, then it is possible to invert the subject with this contraction as a whole. For example:
 * John is going. (affirmative)
 * John is not going. / John isn't going. (negative, with and without contraction)
 * Isn't John going? / Is John not going? (negative question, with and without contraction respectively)

See also.

Dependent clauses
The syntax of a dependent clause is generally the same as that of an independent clause, except that the dependent clause usually begins with a subordinating conjunction or relative pronoun (or phrase containing such). In some situations (as already described) the conjunction or relative pronoun that can be omitted. Another type of dependent clause with no subordinating conjunction is the conditional clause formed by inversion (see below).

Other uses of inversion
The clause structure with an inverted subject and verb, used to form questions as described above, is also used in certain types of declarative sentences. This occurs mainly when the sentence begins with adverbial or other phrases that are essentially negative or contain words such as only, hardly, etc.: Never have I known someone so stupid; Only in France can such food be tasted.

In elliptical sentences (see below), inversion takes place after so (meaning "also") as well as after the negative neither: so do I, neither does she.

Inversion can also be used to form conditional clauses, beginning with should, were (subjunctive), or had, in the following ways: Other similar forms sometimes appear but are less common. There is also a construction with subjunctive be, as in be he alive or dead (meaning "no matter whether he is alive or dead").
 * should I win the race (equivalent to if I win the race);
 * were he a soldier (equivalent to if he were a soldier);
 * were he to win the race (equivalent to if he were to win the race, i.e. if he won the race);
 * had he won the race (equivalent to if he had won the race).

Use of inversion to express a third-person imperative is now mostly confined to the expression long live X, meaning "let X live long".

Imperatives
In an imperative sentence (one giving an order), there is usually no subject in the independent clause: Go away until I call you. It is possible, however, to include you as the subject for emphasis: You stay away from me.

Elliptical constructions
Many types of elliptical construction are possible in English, resulting in sentences that omit certain redundant elements. Various examples are given in the article on Ellipsis.

Some notable elliptical forms found in English include:
 * Short statements of the form I can, he isn't, we mustn't. Here the verb phrase (understood from the context) is reduced to a single auxiliary or other "special" verb, negated if appropriate. If there is no special verb in the original verb phrase, it is replaced by do/does/did: he does, they didn't.
 * Clauses that omit the verb, in particular those like me too, nor me, me neither. The latter forms are used after negative statements. (Equivalents including the verb: I do too or so do I; I don't either or neither do I.)
 * Tag questions, formed with a special verb and pronoun subject: isn't it?; were there?; am I not?

History of English grammars
The first published English grammar was a Pamphlet for Grammar of 1586, written by William Bullokar with the stated goal of demonstrating that English was just as rule-based as Latin. Bullokar's grammar was faithfully modeled on William Lily's Latin grammar, Rudimenta Grammatices (1534), used in English schools at that time, having been "prescribed" for them in 1542 by Henry VIII. Bullokar wrote his grammar in English and used a "reformed spelling system" of his own invention; but much English grammar, for much of the century after Bullokar's effort, was written in Latin, especially by authors who were aiming to be scholarly. John Wallis's Grammatica Linguae Anglicanae (1685) was the last English grammar written in Latin.

Even as late as the early 19th century, Lindley Murray, the author of one of the most widely used grammars of the day, was having to cite "grammatical authorities" to bolster the claim that grammatical cases in English are different from those in Ancient Greek or Latin.

English parts of speech are based on Latin and Greek parts of speech. Some English grammar rules were adopted from Latin, for example John Dryden is thought to have created the rule no sentences can end in a preposition because Latin cannot end sentences in prepositions. The rule of no split infinitives was adopted from Latin because Latin has no split infinitives.

Grammar books

 * A CD-Rom version is included.
 * Curme, George O., College English Grammar, Richmond, VA, 1925, Johnson Publishing company, 414 pages . A revised edition Principles and Practice of English Grammar was published by Barnes & Noble, in 1947.
 * Declerck in his introduction (p.vi) states that almost half his grammar is taken up by the topics of tense, aspect and modality. This he contrasts with the 71 pages devoted to these subjects in The Comprehensive Grammar of English. Huddleston and Pullman say they profited from consulting this grammar in their Cambridge Grammar of the English Language. (p. 1765)
 * Huddleston, Rodney D. (1984) Introduction to the Grammar of English. Cambridge: Cambridge University Press.
 * Huddleston, Rodney D. (1988) English Grammar: An outline. Cambridge: Cambridge University Press.
 * Jespersen, Otto. (1937). Analytic Syntax. Copenhagen: Levin & Munksgaard, 1937. 170 p.
 * Jespersen, Otto. (1909–1949). A Modern English Grammar on Historical Principles (Vols. 1–7). Heidelberg: C. Winter.
 * Korsakov, A. K. (Andreĭ Konstantinovich). 1969. The use of tenses in English. Korsakov, A. K. Structure of Modern English pt. 1. oai:gial.edu:26766 at http://www.language-archives.org/item/oai:gial.edu:26766
 * Three Volumes, translated by Clair James Grece from the German edition Englische Grammatik: Die Lehre von der Wort- und Satzfügung. Professor Whitney in his Essentials of English Grammar recommends the German original stating "there is an English version, but it is hardly to be used." (p. vi)
 * Poutsma, Hendrik. A grammar of late modern English, Groningen, P. Noordhoff, 1914–29, 2 pt. in 5 v. Contents: pt. I. The sentence: 1st half. The elements of the sentence, 1928. 2d half. The composite sentence, 1929.--pt. II. The parts of speech: section I, A. Nouns, adjectives and articles, 1914. section I, B. Pronouns and numerals, 1916. section II. The verb and the particles, 1926.
 * Quirk, Randolph; Greenbaum, Sidney; Leech, Geoffrey; & Svartvik, Jan. (1972). A Grammar of Contemporary English. Harlow: Longman.
 * This book is a translation of Schibsbye's three volume Engelsk Grammatik published between 1957 and 1961. Schibsbye was a student of Jespersen's and co-author of the sixth volume –Morphology –of Jespersen's seven volume Modern English Grammar.
 * Sinclair, John, ed. (1991) Collins COBUILD – English Grammar London: Collins ISBN 0-00-370257-X second edition, 2005 ISBN 0-00-718387-9. Huddleston and Pullman say they found this grammar 'useful' in their Cambridge Grammar of the English Language. (p. 1765) A CD-Rom version of the 1st edition is available on the Collins COBUILD Resource Pack ISBN 0-00-716921-3
 * Sledd, James. (1959) A short introduction to English grammar Chicago: Scott, Foresman.
 * Strang, Barbara M. H. (1968) Modern English structure (2nd ed.) London: Arnold.
 * 4th impression. pts. 1–2. Syntactical units with one verb.--pt.3. 1st half. Syntactical units with two verbs.--pt.3. 2d half. Syntactical units with two and more verbs.
 * Whitney, William Dwight, (1877) Essentials of English Grammar, Boston: Ginn & Heath.
 * Zandvoort, R. W. (1972) A Handbook of English Grammar (2nd ed.) London: Longmans.
 * Peter Herring (2016), The Farlex Grammar Book http://www.thefreedictionary.com/The-Farlex-Grammar-Book.htm
 * Huddleston, Rodney D. (1988) English Grammar: An outline. Cambridge: Cambridge University Press.
 * Jespersen, Otto. (1937). Analytic Syntax. Copenhagen: Levin & Munksgaard, 1937. 170 p.
 * Jespersen, Otto. (1909–1949). A Modern English Grammar on Historical Principles (Vols. 1–7). Heidelberg: C. Winter.
 * Korsakov, A. K. (Andreĭ Konstantinovich). 1969. The use of tenses in English. Korsakov, A. K. Structure of Modern English pt. 1. oai:gial.edu:26766 at http://www.language-archives.org/item/oai:gial.edu:26766
 * Three Volumes, translated by Clair James Grece from the German edition Englische Grammatik: Die Lehre von der Wort- und Satzfügung. Professor Whitney in his Essentials of English Grammar recommends the German original stating "there is an English version, but it is hardly to be used." (p. vi)
 * Poutsma, Hendrik. A grammar of late modern English, Groningen, P. Noordhoff, 1914–29, 2 pt. in 5 v. Contents: pt. I. The sentence: 1st half. The elements of the sentence, 1928. 2d half. The composite sentence, 1929.--pt. II. The parts of speech: section I, A. Nouns, adjectives and articles, 1914. section I, B. Pronouns and numerals, 1916. section II. The verb and the particles, 1926.
 * Quirk, Randolph; Greenbaum, Sidney; Leech, Geoffrey; & Svartvik, Jan. (1972). A Grammar of Contemporary English. Harlow: Longman.
 * This book is a translation of Schibsbye's three volume Engelsk Grammatik published between 1957 and 1961. Schibsbye was a student of Jespersen's and co-author of the sixth volume –Morphology –of Jespersen's seven volume Modern English Grammar.
 * Sinclair, John, ed. (1991) Collins COBUILD – English Grammar London: Collins ISBN 0-00-370257-X second edition, 2005 ISBN 0-00-718387-9. Huddleston and Pullman say they found this grammar 'useful' in their Cambridge Grammar of the English Language. (p. 1765) A CD-Rom version of the 1st edition is available on the Collins COBUILD Resource Pack ISBN 0-00-716921-3
 * Sledd, James. (1959) A short introduction to English grammar Chicago: Scott, Foresman.
 * Strang, Barbara M. H. (1968) Modern English structure (2nd ed.) London: Arnold.
 * 4th impression. pts. 1–2. Syntactical units with one verb.--pt.3. 1st half. Syntactical units with two verbs.--pt.3. 2d half. Syntactical units with two and more verbs.
 * Whitney, William Dwight, (1877) Essentials of English Grammar, Boston: Ginn & Heath.
 * Zandvoort, R. W. (1972) A Handbook of English Grammar (2nd ed.) London: Longmans.
 * Peter Herring (2016), The Farlex Grammar Book http://www.thefreedictionary.com/The-Farlex-Grammar-Book.htm
 * This book is a translation of Schibsbye's three volume Engelsk Grammatik published between 1957 and 1961. Schibsbye was a student of Jespersen's and co-author of the sixth volume –Morphology –of Jespersen's seven volume Modern English Grammar.
 * Sinclair, John, ed. (1991) Collins COBUILD – English Grammar London: Collins ISBN 0-00-370257-X second edition, 2005 ISBN 0-00-718387-9. Huddleston and Pullman say they found this grammar 'useful' in their Cambridge Grammar of the English Language. (p. 1765) A CD-Rom version of the 1st edition is available on the Collins COBUILD Resource Pack ISBN 0-00-716921-3
 * Sledd, James. (1959) A short introduction to English grammar Chicago: Scott, Foresman.
 * Strang, Barbara M. H. (1968) Modern English structure (2nd ed.) London: Arnold.
 * 4th impression. pts. 1–2. Syntactical units with one verb.--pt.3. 1st half. Syntactical units with two verbs.--pt.3. 2d half. Syntactical units with two and more verbs.
 * Whitney, William Dwight, (1877) Essentials of English Grammar, Boston: Ginn & Heath.
 * Zandvoort, R. W. (1972) A Handbook of English Grammar (2nd ed.) London: Longmans.
 * Peter Herring (2016), The Farlex Grammar Book http://www.thefreedictionary.com/The-Farlex-Grammar-Book.htm
 * Whitney, William Dwight, (1877) Essentials of English Grammar, Boston: Ginn & Heath.
 * Zandvoort, R. W. (1972) A Handbook of English Grammar (2nd ed.) London: Longmans.
 * Peter Herring (2016), The Farlex Grammar Book http://www.thefreedictionary.com/The-Farlex-Grammar-Book.htm

Monographs

 * Adams, Valerie. (1973). An introduction to modern English word-formation. London: Longman.
 * Bauer, Laurie. (1983). English word-formation. Cambridge: Cambridge University Press.
 * Fries, Charles Carpenter. (1952). The structure of English; an introduction to the construction of English sentences. New York: Harcourt, Brace.
 * Halliday, M. A. K. (1985/94). Spoken and written language. Deakin University Press.
 * Huddleston, Rodney D. (1976). An introduction to English transformational syntax. Longman.
 * —includes Jespersen's monographs Negation in English and Other Languages, and A System of Grammar.
 * Kruisinga, E. (1925). A handbook of present-day English. Utrecht: Kemink en Zoon.
 * Leech, Geoffrey N. (1971). Meaning and the English verb. London: Longman.
 * Marchand, Hans. (1969). The categories and types of present-day English word-formation (2nd ed.). München: C. H. Beck.
 * McCawley, James D. (1998). The syntactic phenomena of English (2nd ed.). Chicago: The University of Chicago Press.
 * Onions, C. T. (Charles Talbut), (1904, 1st edition) An advanced English syntax based on the principles and requirements of the Grammatical society. London: Keegan Paul, Trench, Trubner & co. A new edition of An advanced English syntax, prepared from the author's materials by B. D. H. Miller, was published as Modern English syntax in 1971.
 * Palmer, F. R. (1974). The English verb. London: Longman.
 * Palmer, F. R. (1979). Modality and the English modals. London: Longman.
 * Plag, Ingo. (2003). Word-formation in English. Cambridge: Cambridge University Press.
 * Scheurweghs, Gustave. (1959). Present-day English syntax: A survey of sentence patterns. London: Longmans.
 * Palmer, F. R. (1979). Modality and the English modals. London: Longman.
 * Plag, Ingo. (2003). Word-formation in English. Cambridge: Cambridge University Press.
 * Scheurweghs, Gustave. (1959). Present-day English syntax: A survey of sentence patterns. London: Longmans.

title: English grammar


text:
Menopause

Menopause, also known as the climacteric, is the time when menstrual periods permanently stop, marking the end of reproduction. It typically occurs between the ages of 45 and 55, although the exact timing can vary. Menopause is usually a natural change. It can occur earlier in those who smoke tobacco. Other causes include surgery that removes both ovaries or some types of chemotherapy. At the physiological level, menopause happens because of a decrease in the ovaries' production of the hormones estrogen and progesterone. While typically not needed, a diagnosis of menopause can be confirmed by measuring hormone levels in the blood or urine. Menopause is the opposite of menarche, the time when a girl's periods start.

In the years before menopause, a woman's periods typically become irregular, which means that periods may be longer or shorter in duration or be lighter or heavier in the amount of flow. During this time, women often experience hot flashes; these typically last from 30 seconds to ten minutes and may be associated with shivering, night sweats, and reddening of the skin. Hot flashes can recur for four to five years. Other symptoms may include vaginal dryness, trouble sleeping, and mood changes. The severity of symptoms varies between women. Menopause before the age of 45 years is considered to be "early menopause" and when ovarian failure/surgical removal of the ovaries occurs before the age of 40 years this is termed "premature ovarian insufficiency".

In addition to symptoms (hot flushes/flashes, night sweats, mood changes, arthralgia and vaginal dryness), the physical consequences of menopause include bone loss, increased central abdominal fat, and adverse changes in a woman's cholesterol profile and vascular function. These changes predispose postmenopausal women to increased risks of osteoporosis and bone fracture, and of cardio-metabolic disease (diabetes and cardiovascular disease).

Medical professionals often define menopause as having occurred when a woman has not had any menstrual bleeding for a year. It may also be defined by a decrease in hormone production by the ovaries. In those who have had surgery to remove their uterus but still have functioning ovaries, menopause is not considered to have yet occurred. Following the removal of the uterus, symptoms of menopause typically occur earlier. Iatrogenic menopause occurs when both ovaries are surgically removed along with uterus for medical reasons.

The primary indications for treatment of menopause are symptoms and prevention of bone loss. Mild symptoms may be improved with treatment. With respect to hot flashes, avoiding smoking, caffeine, and alcohol is often recommended; sleeping naked in a cool room and using a fan may help. The most effective treatment for menopausal symptoms is menopausal hormone therapy (MHT). Non-hormonal therapies for hot flashes include cognitive-behavioral therapy, clinical hypnosis, gabapentin, fezolinetant or selective serotonin reuptake inhibitors. These will not improve symptoms such as joint pain or vaginal dryness which affect over 55% of women. Exercise may help with sleeping problems. Many of the concerns about the use of MHT raised by older studies are no longer considered barriers to MHT in healthy women. High-quality evidence for the effectiveness of alternative medicine has not been found.

Signs and symptoms
During early menopause transition, the menstrual cycles remain regular but the interval between cycles begins to lengthen. Hormone levels begin to fluctuate. Ovulation may not occur with each cycle.

The term menopause refers to a point in time that follows one year after the last menstruation. During the menopausal transition and after menopause, women can experience a wide range of symptoms. However, for women who enter the menopause transition without having regular menstrual cycles (due to prior surgery, other medical conditions or ongoing hormonal contraception) the menopause cannot be identified by bleeding patterns and is defined as the permanent loss of ovarian function.

Vagina, uterus and bladder (urogenital tract)
During the transition to menopause, menstrual patterns can show shorter cycling (by 2–7 days); longer cycles remain possible. There may be irregular bleeding (lighter, heavier, spotting). Dysfunctional uterine bleeding is often experienced by women approaching menopause due to the hormonal changes that accompany the menopause transition. Spotting or bleeding may simply be related to vaginal atrophy, a benign sore (polyp or lesion), or may be a functional endometrial response. The European Menopause and Andropause Society has released guidelines for assessment of the endometrium, which is usually the main source of spotting or bleeding.

In post-menopausal women, however, any unscheduled vaginal bleeding is of concern and requires an appropriate investigation to rule out the possibility of malignant diseases.

Urogenital symptoms (that may appear during menopause and continue through postmenopause) include painful intercourse, vaginal dryness and atrophic vaginitis – thinning of the membranes of the vulva, the vagina, the cervix and the outer urinary tract, along with considerable shrinking and loss in elasticity of all of the outer and inner genital areas – urinary urgency and burning up to urinary incontinence.

Other physical effects
The most common physical symptoms of menopause are heavy night sweats, and hot flashes (also known as vasomotor symptoms). Sleeping problems and insomnia are also common. Other physical symptoms may be reported that are not specific to menopause but may be exacerbated by it, such as lack of energy, joint soreness, stiffness, back pain, breast enlargement, breast pain, heart palpitations, headache, dizziness, dry, itchy skin, thinning, tingling skin, rosacea, weight gain.

Mood and memory effects
Psychological symptoms are often reported but they are not specific to menopause and can be caused by other factors. They include anxiety, poor memory, inability to concentrate, depressive mood, irritability, mood swings, and less interest in sexual activity.

Menopause-related cognitive impairment can be confused with the mild cognitive impairment that precedes dementia. There is evidence of small decreases in verbal memory, on average, which may be caused by the effects of declining estrogen levels on the brain, or perhaps by reduced blood flow to the brain during hot flashes. However, these tend to resolve for most women during the postmenopause. Subjective reports of memory and concentration problems are associated with several factors, such as lack of sleep, and stress.

Cardiovascular health
Exposure to endogenous estrogen during reproductive years provides women with protection against cardiovascular disease, which is lost around 10 years after the onset of menopause. The menopausal transition is associated with an increase in fat mass (predominantly in visceral fat), an increase in insulin resistance, dyslipidaemia, and endothelial dysfunction. Women with vasomotor symptoms during menopause seem to have an especially unfavorable cardiometabolic profile, as well as women with premature onset of menopause (before 45 years of age). These risks can be reduced by managing risk factors, such as tobacco smoking, hypertension, increased blood lipids and body weight.

Bone health
The annual rates of bone mineral density loss are highest starting one year before the final menstrual period and continuing through the two years after it. Thus, post menopausal women are at increased risk of osteopenia, osteoporosis and fractures.

Causes
Menopause can be induced or occur naturally. Induced menopause occurs as a result of medical treatment such as chemotherapy, radiotherapy, oophorectomy, or complications of tubal ligation, hysterectomy, unilateral or bilateral salpingo-oophorectomy or leuprorelin usage.

Age
Menopause typically occurs at some point between 47 and 54 years of age. According to various data, more than 95% of women have their last period between the ages of 44–56 (median 49–50). 2% of women under the age of 40, 5% between the ages of 40–45 and the same number between the ages of 55–58 have their last bleeding. The average age of the last period in the United States is 51 years, in Russia is 50 years, in Greece is 49 years, in Turkey is 47 years, in Egypt is 47 years and in India is 46 years. The menopausal transition or perimenopause leading up to menopause usually lasts 3–4 years (sometimes as long as 5–14 years).

Undiagnosed and untreated coeliac disease is a risk factor for early menopause. Coeliac disease can present with several non-gastrointestinal symptoms, in the absence of gastrointestinal symptoms, and most cases escape timely recognition and go undiagnosed, leading to a risk of long-term complications. A strict gluten-free diet reduces the risk. Women with early diagnosis and treatment of coeliac disease present a normal duration of fertile life span.

Women who have undergone hysterectomy with ovary conservation go through menopause on average 1.5 years earlier than the expected age.

Premature ovarian insufficiency
In rare cases, a woman's ovaries stop working at a very early age, ranging anywhere from the age of puberty to age 40. This is known as premature ovarian failure and affects 1 to 2% of women by age 40. also called premature ovarian insufficiency (POI) It is diagnosed or confirmed by high blood levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH) on at least three occasions at least four weeks apart.

Premature ovarian insufficiency may be auto immune and therefore might co occur with other autoimmune disorders such as thyroid disease, [adrenal insufficiency], and diabetes mellitus. Other causes include chemotherapy, being a carrier of the fragile X syndrome gene, and radiotherapy. However, in about 50–80% of cases of premature ovarian insufficiency, the cause is unknown, i.e., it is generally idiopathic.

An early menopause can be related to cigarette smoking, higher body mass index, racial and ethnic factors, illnesses, and the removal of the uterus.

Rates of premature menopause have been found to be significantly higher in fraternal and identical twins; about 5% of twins reach menopause before the age of 40. The reasons for this are not completely understood.

Surgical menopause
Menopause can be surgically induced by bilateral oophorectomy (removal of ovaries), which is often, but not always, done in conjunction with removal of the fallopian tubes (salpingo-oophorectomy) and uterus (hysterectomy). Cessation of menses as a result of removal of the ovaries is called "surgical menopause". Surgical treatments, such as the removal of ovaries, might cause periods to stop altogether. The sudden and complete drop in hormone levels may produce extreme withdrawal symptoms such as hot flashes, etc. The symptoms of early menopause may be more severe.

Removal of the uterus without removal of the ovaries does not directly cause menopause, although pelvic surgery of this type can often precipitate a somewhat earlier menopause, perhaps because of a compromised blood supply to the ovaries. The time between surgery and possible early menopause is due to the fact that ovaries are still producing hormones.

Mechanism
The menopausal transition, and postmenopause itself, is a natural change, not usually a disease state or a disorder. The main cause of this transition is the natural depletion and aging of the finite amount of oocytes (ovarian reserve). This process is sometimes accelerated by other conditions and is known to occur earlier after a wide range of gynecologic procedures such as hysterectomy (with and without ovariectomy), endometrial ablation and uterine artery embolisation. The depletion of the ovarian reserve causes an increase in circulating follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels because there are fewer oocytes and follicles responding to these hormones and producing estrogen.

The transition has a variable degree of effects.

The stages of the menopause transition have been classified according to a woman's reported bleeding pattern, supported by changes in the pituitary follicle-stimulating hormone (FSH) levels.

In younger women, during a normal menstrual cycle the ovaries produce estradiol, testosterone and progesterone in a cyclical pattern under the control of FSH and luteinizing hormone (LH), which are both produced by the pituitary gland. During perimenopause (approaching menopause), estradiol levels and patterns of production remain relatively unchanged or may increase compared to young women, but the cycles become frequently shorter or irregular. The often observed increase in estrogen is presumed to be in response to elevated FSH levels that, in turn, is hypothesized to be caused by decreased feedback by inhibin. Similarly, decreased inhibin feedback after hysterectomy is hypothesized to contribute to increased ovarian stimulation and earlier menopause.

The menopausal transition is characterized by marked, and often dramatic, variations in FSH and estradiol levels. Because of this, measurements of these hormones are not considered to be reliable guides to a woman's exact menopausal status.

Menopause occurs because of the sharp decrease of estradiol and progesterone production by the ovaries. After menopause, estrogen continues to be produced mostly by aromatase in fat tissues and is produced in small amounts in many other tissues such as ovaries, bone, blood vessels, and the brain where it acts locally. The substantial fall in circulating estradiol levels at menopause impacts many tissues, from brain to skin.

In contrast to the sudden fall in estradiol during menopause, the levels of total and free testosterone, as well as dehydroepiandrosterone sulfate (DHEAS) and androstenedione appear to decline more or less steadily with age. An effect of natural menopause on circulating androgen levels has not been observed. Thus specific tissue effects of natural menopause cannot be attributed to loss of androgenic hormone production.

Hot flashes and other vasomotor and body symptoms accompanying the menopausal transition are associated with estrogen insufficiency and changes that occur in the brain, primarily the hypothalamus and involve complex interplay between the neurotransmitters kisspeptin, neurokinin B, and dynorphin, which are found in KNDy neurons in the infundibular nucleus.

Ovarian aging
Decreased inhibin feedback after hysterectomy is hypothesized to contribute to increased ovarian stimulation and earlier menopause. Hastened ovarian aging has been observed after endometrial ablation. While it is difficult to prove that these surgeries are causative, it has been hypothesized that the endometrium may be producing endocrine factors contributing to the endocrine feedback and regulation of the ovarian stimulation. Elimination of these factors contributes to faster depletion of the ovarian reserve. Reduced blood supply to the ovaries that may occur as a consequence of hysterectomy and uterine artery embolisation has been hypothesized to contribute to this effect.

Impaired DNA repair mechanisms may contribute to earlier depletion of the ovarian reserve during aging. As women age, double-strand breaks accumulate in the DNA of their primordial follicles. Primordial follicles are immature primary oocytes surrounded by a single layer of granulosa cells. An enzyme system is present in oocytes that ordinarily accurately repairs DNA double-strand breaks. This repair system is called "homologous recombinational repair", and it is especially effective during meiosis. Meiosis is the general process by which germ cells are formed in all sexual eukaryotes; it appears to be an adaptation for efficiently removing damages in germ line DNA.

Human primary oocytes are present at an intermediate stage of meiosis, termed prophase I (see Oogenesis). Expression of four key DNA repair genes that are necessary for homologous recombinational repair during meiosis (BRCA1, MRE11, Rad51, and ATM) decline with age in oocytes. This age-related decline in ability to repair DNA double-strand damages can account for the accumulation of these damages, that then likely contributes to the depletion of the ovarian reserve.

Diagnosis
Ways of assessing the impact on women of some of these menopause effects, include the Greene climacteric scale questionnaire, the Cervantes scale and the Menopause rating scale.

Perimenopause
The term "perimenopause", which literally means "around the menopause", refers to the menopause transition years before the date of the final episode of flow. According to the North American Menopause Society, this transition can last for four to eight years. The Centre for Menstrual Cycle and Ovulation Research describes it as a six- to ten-year phase ending 12 months after the last menstrual period.

During perimenopause, estrogen levels average about 20–30% higher than during premenopause, often with wide fluctuations. These fluctuations cause many of the physical changes during perimenopause as well as menopause, especially during the last 1–2 years of perimenopause (before menopause). Some of these changes are hot flashes, night sweats, difficulty sleeping, mood swings, vaginal dryness or atrophy, incontinence, osteoporosis, and heart disease. Perimenopause is also associated with a higher likelihood of depression (affecting from 45 percent to 68 percent of perimenopausal women), which is twice as likely to affect those with a history of depression.

During this period, fertility diminishes but is not considered to reach zero until the official date of menopause. The official date is determined retroactively, once 12 months have passed after the last appearance of menstrual blood.

The menopause transition typically begins between 40 and 50 years of age (average 47.5). The duration of perimenopause may be for up to eight years. Women will often, but not always, start these transitions (perimenopause and menopause) about the same time as their mother did.

Some research appears to show that melatonin supplementation in perimenopausal women can improve thyroid function and gonadotropin levels, as well as restoring fertility and menstruation and preventing depression associated with menopause.

Postmenopause
The term "postmenopausal" describes women who have not experienced any menstrual flow for a minimum of 12 months, assuming that they have a uterus and are not pregnant or lactating. The reason for this delay in declaring postmenopause is that periods are usually erratic during menopause. Therefore, a reasonably long stretch of time is necessary to be sure that the cycling has ceased. At this point a woman is considered infertile; however, the possibility of becoming pregnant has usually been very low (but not quite zero) for a number of years before this point is reached.

In women with or without a uterus, menopause or postmenopause can also be identified by a blood test showing a very high follicle-stimulating hormone level, greater than 25 IU/L in a random blood draw; it rises as ovaries become inactive. FSH continues to rise, as its counterpart estradiol continues to drop for about 2 years after the last menstrual period, after which the levels of each of these hormones stabilize. The stabilization period after the begin of early postmenopause has been estimated to last 3 to 6 years, so early postmenopause lasts altogether about 5 to 8 years, during which hormone withdrawal effects such as hot flashes disappear. Finally, late postmenopause has been defined as the remainder of a woman s lifespan, when reproductive hormones do not change any more.

A period-like flow during postmenopause, even spotting, may be a sign of endometrial cancer.

Management
Perimenopause is a natural stage of life. It is not a disease or a disorder. Therefore, it does not automatically require any kind of medical treatment. However, in those cases where the physical, mental, and emotional effects of perimenopause are strong enough that they significantly disrupt the life of the woman experiencing them, palliative medical therapy may sometimes be appropriate.

Menopausal hormone therapy
In the context of the menopause, menopausal hormone therapy (MHT) is the use of estrogen in women without a uterus and estrogen plus progestogen in women who have an intact uterus.

MHT may be reasonable for the treatment of menopausal symptoms, such as hot flashes. It is the most effective treatment option, especially when delivered as a skin patch. Its use, however, appears to increase the risk of strokes and blood clots. When used for menopausal symptoms the global recommendation is MHT should be prescribed for a long as there are defined treatment effects and goals for the individual woman.

MHT is also effective for preventing bone loss and osteoporotic fracture, but it is generally recommended only for women at significant risk for whom other therapies are unsuitable.

MHT may be unsuitable for some women, including those at increased risk of cardiovascular disease, increased risk of thromboembolic disease (such as those with obesity or a history of venous thrombosis) or increased risk of some types of cancer. There is some concern that this treatment increases the risk of breast cancer. Women at increased risk of cardiometabolic disease and VTE may be able to use transdermal estradiol which does not appear to increase risks in low to moderate doses.

Adding testosterone to hormone therapy has a positive effect on sexual function in postmenopausal women, although it may be accompanied by hair growth or acne if used in excess. Transdermal testosterone therapy in appropriate dosing is generally safe.

Selective estrogen receptor modulators
SERMs are a category of drugs, either synthetically produced or derived from a botanical source, that act selectively as agonists or antagonists on the estrogen receptors throughout the body. The most commonly prescribed SERMs are raloxifene and tamoxifen. Raloxifene exhibits oestrogen agonist activity on bone and lipids, and antagonist activity on breast and the endometrium. Tamoxifen is in widespread use for treatment of hormone sensitive breast cancer. Raloxifene prevents vertebral fractures in postmenopausal, osteoporotic women and reduces the risk of invasive breast cancer.

Other medications
Some of the SSRIs and SNRIs appear to provide some relief from vasomotor symptoms. The most effective SSRIs and SNRIs are paroxetine, escitalopram, citalopram, venlafaxine, and desvenlafaxine. They may, however, be associated with appetite and sleeping problems, constipation and nausea.

Gabapentin or fezolinetant can also improve the frequency and severity of vasomotor symptoms. Side effects of using gabapentin include drowsiness and headaches.

Therapy
Cognitive behavioural therapy and clinical hypnosis can decrease the amount women are affected by hot flashes. Mindfulness is not yet proven to be effective in easing vasomotor symptoms.

Lifestyle and exercise
Exercise has been thought to reduce postmenopausal symptoms through the increase of endorphin levels, which decrease as estrogen production decreases. However, there is insufficient evidence to suggest that exercise helps with the symptoms of menopause. Similarly, yoga has not been shown to be useful as a treatment for vasomotor symptoms.

However a high BMI is a risk factor for vasomotor symptoms in particular. Weight loss may help with symptom management.

There is no strong evidence that cooling techniques such as using specific clothing or environment control tools (for example fans) help with symptoms. Paced breathing and relaxation are not effective in easing symptoms.

Dietary supplements
There is no evidence of consistent benefit of taking any dietary supplements or herbal products for menopausal symptoms. These widely marketed but ineffective supplements include soy isoflavones, pollen extracts, black cohosh, omega-3 among many others.

Alternative medicine
There is no evidence of consistent benefit of alternative therapies for menopausal symptoms despite their popularity.

As of 2023, there is no evidence to support the efficacy of acupuncture as a management for menopausal symptoms. The Cochrane review found not enough evidence in 2016 to show a difference between Chinese herbal medicine and placebo for the vasomotor symptoms.

Other efforts

 * Lack of lubrication is a common problem during and after perimenopause. Vaginal moisturizers can help women with overall dryness, and lubricants can help with lubrication difficulties that may be present during intercourse. It is worth pointing out that moisturizers and lubricants are different products for different issues: some women complain that their genitalia are uncomfortably dry all the time, and they may do better with moisturizers. Those who need only lubricants do well using them only during intercourse.
 * Low-dose prescription vaginal estrogen products such as estrogen creams are generally a safe way to use estrogen topically, to help vaginal thinning and dryness problems (see vaginal atrophy) while only minimally increasing the levels of estrogen in the bloodstream.
 * 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 (ovarian tissue cryopreservation) 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.

Attitudes and experiences
The menopause transition is a process, involving hormonal, menstrual, and typically vasomotor changes. However, the experience of the menopause as a whole is very much influenced by psychological and social factors, such as past experience, lifestyle, social and cultural meanings of menopause, and a woman's social and material circumstances. Menopause has been described as a biopsychosocial experience, with social and cultural factors playing a prominent role in the way menopause is experienced and perceived.

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. There is some evidence that negative attitudes and expectations, held before the menopause, predict symptom experience during the menopause, and, interestingly, beliefs and attitudes toward menopause tend to be more positive in postmenopausal than in premenopausal women. Women with more negative attitudes towards the menopause report more symptoms during this transition.

Menopause is a stage of life experienced in different ways. It can be characterized by personal challenges, changes in personal roles within the family and society. Women's approaches to changes during menopause are influenced by their personal, family and sociocultural background. Women from different regions and countries also have different attitudes. Postmenopausal women had more positive attitudes toward menopause compared with peri- or premenopausal women. Other influencing factors of attitudes toward menopause include age, menopausal symptoms, psychological and socioeconomical status, and profession and ethnicity.

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.

There may be variations in experiences of women from different ethnic backgrounds regarding menopause and care. Immigrant women reported more vasomotor symptoms and other physical symptoms and poorer mental health than non-immigrant women and were mostly dissatisfied with the care they had received. Self-management strategies for menopausal symptoms were also influenced by culture.

Two multinational studies of Asian women, found that hot flushes were not the most commonly reported symptoms, instead body and joint aches, memory problems, sleeplessness, irritability and migraines were. In another study comparing experiences of menopause amongst White Australian women and women in Laos, Australian women reported higher rates of depression, as well as fears of aging, weight gain and cancer – fears not reported by Laotian women, who positioned menopause as a positive event. 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.

As of 2005, in Japanese culture, reporting of vasomotor symptoms has been on the increase, with research 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 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 in 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".

In some women, menopause may bring about a sense of loss related to the end of fertility. In addition, this change often aligns with other stressors, such as the responsibility of looking after elderly parents or dealing with the emotional challenges of "empty nest syndrome" when children move out of the family home. This situation can be accentuated in cultures where being older is negatively perceived.

Impact on work
Midlife is typically a life stage when men and women may be dealing with demanding life events and responsibilities, such as work, health problems, and caring roles. For example, in 2018 in the UK women aged 45–54 report more work-related stress than men or women of any other age group. Hot flashes are often reported to be particularly distressing at work and lead to embarrassment and worry about potential stigmatisation. A June 2023 study by the Mayo Clinic estimated an annual loss of $1.8 billion in the United States due to workdays missed as a result of menopause symptoms. This was one of the largest studies to date examining the impact of menopause symptoms on work outcomes. The research concluded there was a strong need to improve medical treatment for menopausal women and make the workplace environment more supportive to avoid such productivity losses.

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, ("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 Ancient Greeks did not produce medical concepts about any symptoms associated with end of menstruation and did not use a specific word to refer to this time of a woman's life. The word menopause was invented by French doctors at the beginning of the nineteenth century. Greek etymology was reconstructed at this time and it was the Parisian student doctor Charles-Pierre-Louis de Gardanne who invented the a variation of the word in 1812, which was edited to its final French form in 1821.

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.

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.

In popular culture, law and politics
In the 21st century, 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. Subsequently, TV shows have been 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. Davina McCall also led an awareness campaign based on a documentary on Channel 4.

In the UK, Carolyn Harris sponsored the Menopause (Support and Services) Bill in June 2021. It was to exempt hormone replacement therapy from National Health Service prescription charges and to make provisions about menopause support and services, including public education and communication in supporting perimenopausal and post-menopausal women, and to raise awareness of menopause and its effects. The bill was withdrawn on 29 October 2021.

In the US, David McKinley, Republican from West Virginia introduced the Menopause Research Act in September 2022 for $100 million in 2023 and 2024, but it stalled.

Other animals
Few animals have a menopause: humans are joined by just five other species in which females live substantially longer than their ability to reproduce. The others are all cetaceans: beluga whales, narwhals, orcas, false killer whales and short-finned pilot whales.

Menopause has been reported in a variety of other vertebrate species, but these examples tend to be from captive individuals, and thus are not necessarily representative of what happens in natural populations in the wild. Menopause in captivity has been observed in several species of nonhuman primates, including rhesus monkeys and chimpanzees. Some research suggests that wild chimpanzees do not experience menopause, as their fertility declines are associated with declines in overall health. Menopause has been reported in elephants in captivity and guppies. Dogs do not experience menopause; the canine estrus cycle simply becomes irregular and infrequent. Although older female dogs are not considered good candidates for breeding, offspring have been produced by older animals, see Canine reproduction. Similar observations have been made in cats.

Life histories show a varying degree of senescence; rapid senescing organisms (e.g., Pacific salmon and annual plants) do not have a post-reproductive life-stage. Gradual senescence is exhibited by all placental mammalian life histories.

Evolution
There are various theories on the origin and process of the evolution of the menopause. These 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. It is conjectured that in highly social groups natural selection favors females that stop reproducing and devote that post-reproductive life span to continuing to care for existing offspring, both their own and those of others to whom they are related, especially their granddaughters and grandsons.

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: Menopause