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Menopause

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A woman who is starting to feel the first symptoms of menopause.

Menopause is a transitional period in a woman's life where her ovaries cease their production of eggs, the body produces less estrogen and progesterone, and menstruation becomes less frequent, and eventually stops altogether. [1] It is officially defined as occurring twelve months after a woman's last menstrual period. The process of menopause itself is simply a natural biological process that takes place in a woman, not a disease that needs to be cured or eliminated. However, the process does take its toll on women, and it does sometimes cause an emotional response in women that can make them feel depressed. However, just because menopause eliminates the possibility of a woman ever having children again does not mean that she has lost any of her femininity. It simply means that her time to have children is over, and they can now continue to live through the rest of their life without the possibility of having to raise a child. If a woman does develop serious symptoms during menopause, she should schedule an appointment with her doctor. [2] [3] [4] [5]

Contents

Symptoms

The symptoms of the start of menopause can range depending on the woman. In some women, menstrual flow comes to a sudden halt, but it is more common for it to slowly stop over a period of time. During this time, the menstrual periods generally become either more closely or more widely spaced than normal. This can last for about one to three years before menstruation ends completely. The most common symptoms of menopause are:

  • Pounding or racing heart
  • Hot flashes
  • Night sweats
  • Skin flushing
  • Sleeping problems, also known as insomnia

Other less common symptoms may include:

  • A decreased interest in sex, or possibly a decreased response to sexual stimulation
  • An irregular heartbeat (palpitations)
  • Decreased fertility
  • Forgetfulness (only in certain women)
  • Increased abdominal fat
  • Irregular menstrual periods
  • Joint aches and pains
  • Loss of breast fullness
  • Mood swings, irritability, depression, and anxiety
  • Thinning hair
  • Urine leakage
  • Vaginal dryness and painful sexual intercourse
  • Vaginal infections

[1] [2] [3] [4] [5]

Cause and Effect

Menopause is a naturally occurring event that happens in a woman's life between the ages of 45 and 55. The symptoms of menopause are caused by the changes in the estrogen and progesterone levels. The ovaries begin to make less of these hormones over time. The gradual decrease of estrogen production generally allows for a woman's body to slowly adjust to the hormonal changes. Hot flashes and sweats are usually at their worst for the first few years. Menopause itself may last for five years or more.

After certain medical treatments, estrogen levels may drop quite suddenly, as is seen when the ovaries are removed surgically, which is called surgical menopause. The result of this rapid fall of hormones is a number of changes in the entire reproductive system. The vaginal walls become thinner and less elastic, the vagina becomes short, the lubricating secretions from the vagina become watery, and the outside genital tissue thins. This is called atrophy of the labia.[1] [4]

Hysterectomy is another possible, but not very likely, cause of menopause. Having a hysterectomy means for a woman to have her uterus removed, but not the ovaries. This causes women to stop having periods, but the ovaries will still release eggs, along with the continuous production of estrogen and progesterone. A total hysterectomy and bilateral oophorectomy that removes both the uterus and the ovaries does cause menopause, without any sort of transitional phase. A woman stops having periods immediately, and she's likely to have hot flashes and other menopausal signs and symptoms.

Some other things that can induce the start of menopause are chemotherapy, radiation therapy, and primary ovarian insufficiency. Chemotherapy and radiation therapy are cancer treatments that can induce early menopause, causing hot flashes during the course of treatment, as well as within three to six months afterwards. Primary ovarian insufficiency is basically premature menopause that effects about one percent of women in the world before they reach the age of forty. When a woman's ovaries fail to produce the normal amount of reproductive hormones, which sometimes stems from genetic factors or autoimmune disease, the woman has primary ovarian insufficiency, which induces the premature start of menopause.[2]

Once menopause is complete, now called post-menopause, and a woman has not had a period for one year, she is no longer able to become pregnant.[1] [2]

Prevention

Menopause is not necessarily something that needs to be prevented because it is a natural part of a woman's life. However, there are certain ways to reduce or eliminate some of the symptoms of menopause. A woman can reduce her risk of long-term problems such as osteoporosis and heart disease by following these steps:

  • Controlling their blood pressure, cholesterol, and other risk factors for heart disease
  • Not smoking. Cigarette use can cause early menopause, as well as lung cancer
  • Eat a low-fat diet.
  • Regular exercise. Resistance exercises help strengthen your bones and improve your balance
  • If you show early signs of bone loss, talk to your doctor about medications that can help stop further weakening
  • Take calcium and vitamin D

[1] [4]

Tests and Diagnosis

Blood and urine tests are the most commonly used tests to measure changes in hormone levels that may signal when a woman is close to menopause or has already gone through menopause. Examples of these tests are:

  • Estradiol
  • FSH
  • LH

[1] [2] [4]

A pelvic examination can indicate changes in the vaginal lining caused by declining estrogen levels. A doctor may perform a bone density test to screen for low bone density levels that occur with osteoporosis.[1]

Treatment

Some treatments with certain hormones may be helpful if a woman has severe symptoms such as hot flashes, mood issues, night sweats, or vaginal dryness. The decision to use hormone treatment must be thoroughly discussed with one's doctor in order to weigh the risks against the possible benefits. Every woman is a unique individual, and it is extremely necessary to know one's medical history before prescribing hormone therapy.

Hormone Therapy

Several major studies have questioned the health benefits and risks of hormone replacement therapy, including the risk of developing breast cancer, having heart attacks or strokes, and the forming of blood clots. There are some current guidelines that support the use of HT (Hormone Therapy) for the treatment of hot flashes. Some specific recommendations are:

  • Therapy may be started in women who have recently entered the first stages of menopause
  • Hormone Replacement Therapy should not be used in women who started menopause many years ago
  • Medication should not be used for any longer than 5 years
  • Women taking Hormone Therapy should have a baseline low risk for blood clots, breast cancer, heart disease, or a stroke

In order to reduce the risks of estrogen therapy and still gain the benefits of the treatment, doctors may recommend:

  • Frequent and regular pelvic exams and Pap smears to detect any problems as early as possible
  • Frequent and regular physical exams, including breast exams and mammograms
  • Estrogen or progesterone regimens that do not contain the form of progesterone used in the study
  • A lower dose of estrogen or a different estrogen preparation (for instance, a vaginal cream rather than a pill)

[1] [2] [4] [5]

Alternatives to Hormone Therapy

Medications for symptoms of menopause.

There are certain medications besides Hormone Therapy that help with mood swings, hot flashes, and other various symptoms. These may include small doses of antidepressants such as bupropion (Wellbutrin), paroxetine (Paxil), venlafaxine (Effexor), and fluoxetine (Prozac), or clonidine, which is normally used to control high blood pressure. Gabapentin is also effective for the reducing of hot flashes.[1] [2] [4] along with these medications, women also have the options of taking medication such as bisphosphonates, selective estrogen receptor modulators, also known as SERMs, and/or vaginal estrogen. Bisphosphonates are nonhormonal medications, such as alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva), in order to prevent or treat the possibility of a menopausic woman becoming diagnosed with osteoporosis. These medications help to reduce both bone loss and a woman's risk of fracture, along with a replacement of estrogen as their main treatment.

Selective estrogen receptor modulators are a large group of drugs that such as raloxifene (Evista), which mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks that are associated with estrogen. Vaginal estrogen is a treatment that is used to reduce vaginal dryness. Estrogen is administered locally through a vaginal tablet, ring or cream, whcih releases only a small amount of estrogen. This is absorbed by the vaginal tissue, which helps relieve any vaginal dryness, discomfort with intercourse, and some urinary symptoms.[2]

Other remedies for menopausic symptoms, particularly hot flashes, are simple, easy, and don't require medication. certain things that help women having trouble with annoying symptoms are:

  • Dress in layers that you can take off if you get too warm
  • Have a cold drink (water or juice) when a flash is starting
  • If night sweats wake you, sleep in a cool room or with a fan on
  • Try to keep track of when hot flashes happen—a diary can help (Women might be able to use this information to find out what triggers their flashes and then avoid those triggers)
  • Use sheets and clothing that let your skin “breathe”
  • When a hot flash starts try to go somewhere cool

[3]

Complications

Unfortunately, there can be some complications with menopause. Postmenopausal bleeding may occur, but this bleeding is often nothing to worry about. However, your health care provider should always check any postmenopausal bleeding, because it may be an early sign of other problems, including cancer.

Decreased estrogen levels are also associated with the following long-term effects, such as:

  • Bone loss and eventual osteoporosis in some women
  • Changes in cholesterol levels and greater risk of heart disease

[1] [3]

Along with osteoporosis, women may also develop cardiovascular disease, urinary inconsistency, and weight gain. Since cardiovascular disease is the leading cause of death for women, as well as men, it is a good idea to find out in what ways one can reduce the risk of getting any. In order to decrease one's risk of being diagnosed with a cardiovascular disease, see the Lifestyle Changes section.

Urinary inconsistence is the result of the tissues of your vagina and urethra loosing their elasticity. Women may frequently experience strong and sudden urges to urinate, which is usually followed by an involuntary loss of urine, along with the possibility of the loss of urine with coughing or laughing.

Weight gain is another complication of menopause. The best way for women to stop this is to eat less, meaning as many as 200 to 400 fewer calories each day, and exercise more often.[2]

Lifestyle Changes

There are certain steps in a woman's life that can be taken in order to reduce symptoms without having to take hormones. These changes are:

  • Avoid eating/drinking any caffeine, alcohol, and spicy foods
  • Dress lightly but in layers
  • Eat soy foods
  • Get an adequate amount of calcium and vitamin D in food and/or supplements
  • Get plenty of exercise
  • Perform Kegel exercises daily to strengthen the muscles of your vagina and pelvis
  • Practice slow, deep breathing whenever a hot flash starts to come on (try taking six breaths per minute)
  • Remain sexually active
  • See an acupuncture specialist
  • Try certain relaxation techniques such as yoga, tai chi, or meditation
  • Use water-based lubricants during sexual intercourse

[1] [3] [4] [5]

References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 Menopause by A.D.A.M. (visited May 8, 2010).
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Menopause by MayoClinic (visited May 9, 2010).
  3. 3.0 3.1 3.2 3.3 3.4 Menopause by The National Institute of Aging (visited May 9, 2010).
  4. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 Menopause by Medline Plus (visited May 9, 2010).
  5. 5.0 5.1 5.2 5.3 Menopause and Menopause Treatments by Womens Health.gov (visited May 9, 2010).

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