Menopause

What is Menopause?

Doctors define menopause as the time after 12 months have passed since your last period. Your mother or grandmother may call menopause “the change”, it isn’t just a single event. Menopause is a series of changes that usually starts in your 40’s and last into your 50’s.

Menopause is a natural process, not a medical illness.  It’s not associated with hormonal, physical, or psychosocial changes in your life, and it isn’t the end of your youth or sexuality.  Many years ago, women generally didn’t live beyond menopause.  Today, you may spend half your life after menopause. The health risks related to the loss of estrogen, however, increase as the woman ages.  You can do many things to relieve the signs and symptoms of menopause, prevent complications, and improve your health during this important stage of life.

Menopause occurs when your ovaries no longer produce an egg every month, and menstruation stops. Natural menopause usually occurs gradually and is described in three stages. Perimenopause is what begins several years before menopause.  The ovaries gradually produce less estrogen. Perimenopause will last up until menopause, when the ovaries stop releasing eggs.  The production of estrogen decreases faster in the last one or two years of perimenopause, at which point the body is ready to experience menopause. 

Menopause is the next stage of the whole menopausal cycle. This is the point when its been a year since a woman has had her last menstrual period.  At this point in time, the ovaries have completely stopped releasing eggs and producing most of their estrogen.  Three years after menopause, the final stage called postmenopause occurs. During this stage, menopausal symptoms, such as hot flashes, begin to ease for most women.

Signs and Symptoms of Menopause

Not all women experience the same menopausal symptoms.  Even the age at which menopause begins may be unique to you.  Some women reach menopause in their 30s or 40s, and some not until thier 60s.  On average, menopause most often occurs between the ages of 50 and 51.  You may breeze through with very few signs of menopause and symptoms, or you may notice a number of physical and emotional changes. 

Some of these changes include:

• Irregular Menstruation – Your cycle may stop suddenly, or gradually get lighter or heaver and then stop.  The unpredictability of your periods may be your first clue that menopause is starting.
• Vaginal changes – You may notice the tissues lining your vagina and urethra become drier, thinner, and less elastic.  With a decrease in lubrication you may have burning, itching, along with an increase risk of infections or your urinary tract or vagina.  These changes can make sexual intercourse uncomfortable or painful.
• Hot flashes – As your estrogen level decreases, your blood vessels may expand rapidly causing your skin temperature to rise.  This may lead to a feeling of warmth that moves up from your chest to your shoulders, neck, and head.  You may perspire, and as the sweat evaporates from your skin, you might feel chills.  Your face may look flushed, and there may be red blotches on your chest neck and arms.  Hot flashes usually last from 30 seconds to several minutes, however it is possible that they can last much longer.  The number of flashes you have will vary from person to person.
• Trouble sleeping and night sweats – Night sweats are usually a consequence of hot flashes.  You may wake up from a deep sleep with soaking night sweats followed by chills.  You may have trouble falling back to sleep or achieving a deep, restful sleep.  A lack of sleep can affect your mood and overall health.
• Changes in appearance – The fat that once was concentrated in your hips and thighs may settle above your waist and in  your abdomen.  You may notice a loss of fullness in your breasts, thinning hair, and wrinkles on your skin.  If you have previously had adult acne, it may become worse.  When you estrogen level drops, your body may still continue to produce small amounts of the male hormone testosterone.  This may cause you to develop coarse hair on your chin, upper lip, chest, and abdomen.
• Emotional changes – As you go through menopause, you may have mood swings, be more irritable or become more prone to emotional upsets.  These symptoms were once a part of hormonal fluctuations, however now other factors may contribute to your mood changes.  Other factors include stress, insomnia, and life events that can occur in this stage of adulthood – such as illness or death of a parent, grown children leaving home, and retirement.

Other symptoms include increased anxiety or irritability, and the need to urinate more frequently.

What Causes Menopause?

Menopause occurs when your ovaries no longer produce an egg every month, and menstruation stops. Natural menopause usually occurs gradually and is described in three stages.

Perimenopause is what begins several years before menopause.  The ovaries gradually produce less estrogen.  Perimenopause will last up until menopause, when the ovaries stop releasing eggs.  The production of estrogen decreases faster in the last one or two years of perimenopause, at which point the body is ready to experience menopause.

Menopause is the next stage of the whole menopausal cycle.  This is the point when its been a year since a woman has had her last menstrual period.  At this point in time, the ovaries have completely stopped releasing eggs and producing most of their estrogen.

Three years after menopause, the final stage called postmenopause occurs.  During this stage, menopausal symptoms, such as hot flashes, begin to ease for most women.

What are the Risk Factors for Menopause?

Menopause is generally a natural process, but certain surgical or medical treatments can cause menopause to begin earlier than expected.

These treatments include:

• Hysterectomy – A hysterectomy which removes your uterus but not your ovaries usually doesn’t cause menopause.  You no longer have periods, but your ovaries will still release eggs.  In an operation that removes both your uterus and your ovaries does cause menopause.  There is no perimenopausal phase.  Instead, your period stops immediately and you are likely to have hot flashes and other menopausal symptoms.
• Chemotherapy and radiation therapy – cancer therapies can induce menopause.  They usually do this gradually, and you may have months or years of perimenopausal symptoms before you actually reach the menopause stage.

How is Menopause Diagnosed?

A test isn’t usually needed to confirm menopause in women.  A woman is in menopause if she has no menstrual periods for 12 months and has no other medical reason for these periods to stop.  That means she has to be evaluated by her doctor to exclude medical causes for missed periods.  Often, the signs and symptoms are enough to tell if a woman has begun going through the menopausal process.  If you have concerns about irregular periods or hot flashes, talk to your doctor.  In some cases, it may be important to rule out other problems.

Your doctor can test you to see if you are in menopause, however there is no saying how reliable the test may be. Because hormone levels fluctuate during menopause, hormone tests are not the most accurate to determine if you are in menopause.  Your hormone levels may change drastically from day to day.  If you want to test for menopause anyway, they check your level of follicle-stimulating hormone (FSH) and estrogen (estradiol) with a simple blood test.  As menopause occurs, FSH levels increase and estradiol levels decrease.  If your FSH level is above 30 and your estradiol level is less than 20, you’ve probably gone through menopause.  If these tests are taken while you’re taking birth control pills, these tests need to be done at the end of your hormone free week.

How is Menopause Treated?

Menopause can be treated with many different approaches including diet changes, medication, and exercise.

There is no medical treatment needed for menopause.  Treatments focus on relieving the signs and symptoms of menopause, and preventing or decreasing chronic conditions that may occur during the postmenopausal stage. 

Some treatments include:

1. Hormone replacement therapy – this therapy provides a low dose of estrogen which is  often taken in combination with progestin.  This method has been effective in treating signs and symptoms of menopause such as hot flashes, and vaginal dryness and discomfort during intercourse. HRT may be taken in numerous forms including a pill, a patch, a cream, or a vaginal ring.  Each form diagnosed to you is customized to fit your needs.
   Women who have undergone a hysterectomy take HRT as estrogen alone.  Most other women who take HRT are told to use a combination of estrogen and progestin because progestin helps protect against uterine cancer.  HRT taken as estrogen alone or as a combination therapy prevents bone loss and osteoporosis.  Not all effects of HRT are positive.  Taking HRT as a combination hormone therapy can result in serious side effects and health risks.  Talk to your doctor about the options and decide what is best for you.
2. Bisphosphonates – These are nonhormonal medications that doctors use to prevent or treat osteoporosis.  These include medicines like alendronate (Fosamax) and risedronate (Actonel).  These medications don’t provide the same protection for you bones as estrogen does, however they reduce both bone loss and your risk of fractures.  Alendronate may cause gastrointestinal problems and irritation of your esophagus.
3. Selective estrogen receptor modulators – SERMs are among a group of drup that includes raloxifene (Evista).  These drugs have some of the same benefits of estrogen, especially improved bone strength, but they do not increase the risk of breast cancer or uterine bleeding.  These medications tend to cause, however, rather than relieve hot flashes, and increase your risk of blood clots and gallstones.

Talk to your doctor about your options and the risks and benefits involved before deciding on a form of treatment.

Self-Care

Many of the signs and symptoms that occur during menopause are only temporary.

Here are some steps to help prevent or reduce their effects:

• Hot/cool flashes – Get regular exercise, dress in layers, and try to pinpoint what triggers your hot flashes.  For many women, triggers include hot beverages, spicy foods, alcohol, hot weather, and even a warm room.
• Vaginal discomfort – For vaginal dryness or discomfort during intercourse, use over-the-counter water based lubricants (Astroglide, K-Y Jelly) or moisturizers (Replens, Vagisil.)  Staying sexually active on a regular basis also helps minimize problems with dryness.
• Trouble sleeping – Avoid caffeinated beverages and exercise right before bed.  Practicing relaxation techniques such as deep breathing, guided imagery, and progressive muscle relaxation can be helpful.  You can find many books and tapes on different relaxation techniques.
• Night Sweats – If you experience night sweats, wear cool airy cotton clothing to bed and keep an extra set handy.
• Urinary incontinence – pelvic floor muscle exercises (Kegel exercises) can improve some forms of urinary incontinence.
• Eating well – Eat a healthy balanced diets that includes a variety of fruits, vegetables and grains.  Limit your intake of fats, oils, and sugars.  Make sure your intake of calcium is at least 1,200 to 1,500 mg daily.  If you’re not taking estrogen, ask your physician about calcium supplements.
• Don’t smoke – You already know that smoking increases your risk of heart disease, stroke, cancer, and many other health problems.  Smoking may also increase hot flashes and bring on an earlier menopause.
• Exercise – Thirty minutes of exercise a few days a week is a good goal.  This will help you prevent cardiovascular disease, diabetes, and osteoporosis.  Exercise also reduces stress.  Try a combination of weight-bearing aerobic activities such as walking, jogging, and dancing, and strength- training exercises.
• Visit your doctor – Talk to your doctor about how often you should have mammograms, Pap tests, and other screening tests to make sure you are staying healthy.