Topic: Women & Menopause Posted: 10 May 2007 at 4:01pm
Women & Menopause
It wasn't too long ago that lack of knowledge and cultural embarrassment disguised natural female biological functions under a cloak of terms such as 'the curse', 'that time of month' and 'the change of life'. These cycles of life were thought of in the same manner one would ascribe to a disease. Times change, as does the female body, and now menstruation and menopause can be uttered without a blush and understood as a normal progression of life.
Although menstruation and menopause are and have been part of normal female development throughout time, science and medicine still do not understand all of the ramifications attached to these women only issues, especially menopause. Aristotle noted that the menses cycles ended in women around the age of forty five and it has taken all of these centuries to learn more about what actually happens to the body and the effects of this transition. It's really rather pitiful that here, in the first decade of the twenty first century, we are just beginning to learn about our bodies, what takes place in them and the results of those changes. The good news is more and more correlative research is being compiled and factual information is beginning to surface.
Menopause is defined as the cessation of menstruation as a result of the normal decline in ovarian function. Technically, you enter menopause following 12 consecutive months without a period. Menopause has become increasingly medicalized, which means it is viewed as something that requires intervention and treatment rather than as a natural life transition that may benefit from support. Menopause signals the end of fertility and the beginning of a new and potentially rewarding time in a woman's life. Part of the stigma of menopause is its association with aging, but we age no more rapidly in our 50s than in any other decade of life.
When Does Menopause Happen?
For most women, natural menopause occurs between the ages of 45 and 55, with the average age of onset being 51.4 years of age. In rare instances, menopause can occur as early as the 30's or as late as the 60's. Menopause is considered premature if it occurs before the age of 40, or artificial if radiation exposure, chemotherapeutic drugs, or surgery induces it. Other factors that may contribute to the early onset of menopause include a history of smoking, poor nutrition, a co-existing medical condition, or even a traumatic experience.
Until a woman is technically considered menopausal (aka postmenopausal), she's considered to be premenopausal, also referred to as perimenopause. It's during the perimenopausal phase that most women experience the worst symptoms.
Menopause (or postmenopause) occurs when a woman hasn't had her period for 12 consecutive months. Once hormones have levelled off, most of the symptoms experienced during perimenopause will disappear -- although some women have occasional hot flashes, anxiety, bouts of depression, et al, for a few years after they become postmenopausal.
Every woman's period will stop at menopause. Some women may not have any other symptoms. But as you near menopause, you may have these symptoms:
Changes in your period. The time between periods and the flow from month to month may be different.
Abnormal bleeding or "spotting." This is common as you near menopause. But if your periods have stopped for 12 months in a row, and you still have "spotting," you should talk to your doctor to rule out serious causes, like cancer.
Hot flashes ("hot flushes"). You get warm in the face, neck and chest.
Night sweats and sleeping problems. These may lead to feeling tired, stressed, or tense.
Vaginal changes. The vagina may become dry and thin, and sex and vaginal exams may be painful. You also might get more vaginal infections.
Thinning of your bones. This may lead to loss of height and bone breaks (osteoporosis).
Mood changes. May include mood swings, depression, and irritability.
Urinary problems. You may have leaking, burning or pain when urinating, or leaking when sneezing, coughing, or laughing.
Lack of concentration. You may become forgetful.
Sex drive decreases. You may have less interest in sex and changes in sexual response.
Weight fluctuation. Weight gain or increase in body fat around your waist.
Hair loss or thinning. Hair thinning or loss is a problem for some women.
Depression. Some researchers believe that the decrease in estrogen triggers changes in your brain, causing depression.
As you near menopause, you may have symptoms from the changes your body is making. Here are some ways to relieve those symptoms.
Hot Flashes. A hot environment, eating or drinking hot or spicy foods, alcohol, or caffeine, and stress can bring on hot flashes. Try to avoid these triggers. Dress in layers and keep a fan in your home or workplace. Regular exercise might also bring relief from hot flashes and other symptoms. Ask your doctor about taking an antidepressant medicine. There is proof that this can be helpful for some women.
Vaginal Dryness. Use an over-the-counter vaginal lubricant. There are also prescription estrogen replacement creams that your doctor might give you. If you have spotting or bleeding while using estrogen creams, you should see your doctor.
Problems Sleeping. One of the best ways to get a good night's sleep is to get at least 30 minutes of physical activity on most days of the week. But avoid a lot of exercise close to bedtime. Also avoid alcohol, caffeine, large meals, and working right before bedtime. You might want to drink something warm, such as herb tea or warm milk, before bedtime. Try to keep your bedroom at a comfortable temperature. Avoid napping during the day and try to go to bed and get up at the same times every day.
Memory problems. Ask your doctor about mental exercises you can do to improve your memory. Try to get enough sleep and be physically active.
Mood swings. Try to get enough sleep and be physically active. Ask your doctor about relaxation exercises you can do. Ask your doctor about taking an antidepressant medicine. There is proof that this can be helpful. Think about going to a support group for women who are going through the same thing as you, or getting counseling to talk through your problems and fears.
Since we're always learning more about menopause treatment options and hormone therapy, it can be confusing to figure out how to treat or manage menopausal symptoms. It is important for you to have a doctor that you trust, so you can have an open talk about your concerns and your treatment options. Then you can make informed decisions about your health that you feel good about. If you feel that you have talked openly with your doctor and still don't feel satisfied, you should think about getting a second opinion.
Knowing how to talk to your doctor or other members of your health care team can help you get the information you need about menopause. Your doctor will tell you, as you near menopause, that you may have symptoms from the changes your body is making. For some women, their menopause symptoms will go away over time without treatment. Other women will choose treatment for their symptoms.
Talk to your doctor about how to best manage menopause. Talk about your symptoms and whether they bother you. Make sure the doctor knows your medical history and your family medical history. This includes whether you are at risk for heart disease, osteoporosis, and breast cancer. Remember that your decision is never final. You can, and should review it with your doctor during a checkup. Your needs may change, and so might what we know about menopause.
The use of hormone therapy has been debated a great deal since the Women's Health Initiative (WHI) Hormone Study findings were released in 2002. Before this study, it was thought that hormone therapy could ward off heart disease, osteoporosis, and cancer, while improving women's quality of life. Findings emerged from clinical trials that showed this was not so. In fact, long-term use of hormone therapy poses serious risks and may increase the risk of heart attack and stroke.
During perimenopause, some doctors suggest birth control pills to help with very heavy, frequent, or unpredictable menstrual periods. These pills might also help with symptoms like hot flashes, as well as prevent pregnancy. As you get closer to menopause, you might be bothered more by symptoms like hot flashes, night sweats, or vaginal dryness. Your doctor might then suggest taking estrogen, as well as progesterone, if you still have a uterus. Taking these hormones will probably help with menopause symptoms and prevent the bone loss that can happen at menopause. However, there is a chance your symptoms will come back when you stop hormone therapy.
Currently, hormone therapy is recommended for postmenopausal women who have moderate to severe hot flashes or night sweats. Instead of hormone pills, topical hormones like vaginal creams are recommended for women who have problems with vaginal dryness. Women should talk about these issues with their doctors, who also may prescribe hormones to prevent osteoporosis if other kinds of medicines cannot be taken. Postmenopausal women should not take hormone therapy as they grow older to prevent problems like heart disease.
Hormone therapy can help with menopause by:
Reducing hot flashes
Treating vaginal dryness
Slowing bone loss
Decreasing mood swings and depression
For some women, hormone therapy may increase their chance of getting:
Gall bladder disease
Who should NOT take hormone therapy for menopause:
Women who . . .
Think they are pregnant
Have problems with vaginal bleeding
Have had certain kinds of cancers (such as breast and uterine cancer)
Have had a stroke or heart attack
Have had blood clots
Have liver disease
Hormone therapy can also cause these side effects:
You may want to consider alternatives to hormone therapy to ease menopausal symptoms. Some women decide to take herbal, natural, or plant-based products to help their symptoms. But there is not enough evidence to know if treatments like these are helpful. Tell your doctor if you are taking any of these treatments. They may have side effects or make another drug not work as well. Some of the most common ones are:
Soy. This contains phytoestrogens (estrogen-like substances from a plant). Some research has shown that soy food products can help with mild hot flashes. Other research suggests that women who have been diagnosed with estrogen-dependent breast cancer should be cautious with their soy intake. Eating large amounts of soy products could be harmful for women with this type of breast cancer.
Other sources of phytoestrogens. The active ingredients in most dietary supplements for menopause are phytoestrogens — chemicals found in plants that may act like the estrogen produced naturally in the body. These include herbs, such as black cohosh, wild yam, dong quai, and valerian root.
Bioidentical hormone therapy. Bioidentical hormones are custom-mixed formulas containing various hormones that are chemically identical to those naturally made by your body. These over-the-counter products are marketed as being tailored to a woman's individual hormone needs. There are two main types of Bioidentical hormones:
Those that are FDA-approved and commercially available with a prescription
Those that are mixed on an individual basis for women in compounding pharmacies, which are NOT FDA-approved
It is important to know that alternative therapies can affect medical care by introducing personal belief systems that are not typically a part of the doctor-patient relationship.
Premature menopause is menopause that happens before the age of 40 — whether it is natural or induced. Women who enter menopause early get symptoms similar to those of natural menopause, like hot flashes, emotional problems, vaginal dryness, and decreased sex drive. For some women with early menopause, these symptoms are severe. Also, women who have early menopause tend to get weaker bones faster than women who enter menopause later in life. This raises their chances of getting osteoporosis and breaking a bone. Premature menopause can happen for these reasons.
Chromosome defects. Defects in the chromosomes can cause premature menopause. For example, women with Turner's syndrome are born without a second X chromosome or born without part of the chromosome. The ovaries don't form normally, and early menopause results.
Genetics. Women with a family history of premature menopause are more likely to have early menopause themselves.
Autoimmune diseases. The body's immune system, which normally fights off diseases, mistakenly attacks a part of its own reproductive system. This hurts the ovaries and prevents them from making female hormones. Thyroid disease and rheumatoid arthritis are two diseases in which this can happen.
Surgery to Remove the Ovaries. Surgical removal of both ovaries, also called a bilateral oophorectomy, puts a woman into menopause right away. She will no longer have periods, and hormones decline rapidly. She may have menopausal symptoms right away, like hot flashes and diminished sexual desire. Women who have a hysterectomy, but have their ovaries left in place, will not have induced menopause because their ovaries will continue to make hormones. But because their uterus is removed, they no longer have their periods and cannot get pregnant. They might have hot flashes since the surgery can sometimes disturb the blood supply to the ovaries. Later on, they might have natural menopause a year or two earlier than expected.
Chemotherapy or Pelvic Radiation Treatments for Cancer. Cancer chemotherapy or pelvic radiation therapy for reproductive system cancers can cause ovarian damage. Women may stop getting their periods, have fertility problems, or lose their fertility. This can happen right away or take several months. With cancer treatment, the chances of going into menopause depend on the type of chemotherapy used, how much was used, and the age of the woman when she gets treatment. The younger a woman is, the less likely she will go into menopause.
How to Find Out if You Have Premature Menopause
Your doctor will ask you if you've had changes typical of menopause, like hot flashes, irregular periods, sleep problems, and vaginal dryness. Normally, menopause is confirmed when a woman hasn't had her period for 12 months in a row.
However, with certain types of premature menopause, these signs may not be enough for a diagnosis. A blood test that measures follicle-stimulating hormone (FSH) can be done. Your ovaries use this hormone to make estrogen. FSH levels rise when the ovaries stop making estrogen. When FSH levels are higher than normal, you've reached menopause. However, your estrogen levels vary daily, so you may need this test more than once to know for sure.
You may also have a test for levels of estradiol (a type of estrogen) and luetinizing hormone (LH). Estradiol levels fall when the ovaries fail. Levels lower than normal are a sign of menopause. LH is a hormone that triggers ovulation. If you test above normal levels, you've gone through menopause.
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