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Menopause

Perhaps you have reached “a certain age”. Maybe you’ve already noticed some changes, and are wondering what to expect next. The “change of life” can be exciting, scary, sad, exhilerating, mysterious, peaceful, or all of and none of the above.

What is menopause?

Menopause is the permanent end of menstruation and fertility. It happens when the ovaries greatly reduce production of the sex hormones estrogen and progesterone. Menopause is confirmed when twelve months have passed since your last normal period (assuming there is no other reason for the lack of periods). If you had a hysterectomy prior to menopause, but kept your ovaries, you may need blood tests to determine whether you have reached menopause. After menopause, it is no longer possible to become pregnant. Other changes also occur at this time.

Most women experience menopause between the ages of 45 and 55. The average is around 51. Cigarette smokers tend to reach menopause earlier than nonsmokers. If menopause occurs before age 40, it is considered “premature”. Premature menopause may happen naturally, or it may be caused by another medical condition, injury to the ovaries, or surgery.

Most people also use the word “menopause” to refer to the transitional period of a few years leading up to actual menopause. The medical term for this time is “perimenopause”.

What causes menopause?

Natural menopause occurs when the body’s production of sex hormones declines dramatically. Ovulation and menstruation no longer occur. After menopause, the adrenal glands continue to produce androstenedione, which is converted in fat cells to a form of estrogen called estrone. Because obese women have more fat, they may produce more estrone, resulting in fewer menopausal symptoms. The levels of two other hormones, progesterone and testosterone, also drop at this time.

Menopause can also occur as the result of disease, injury, or surgery. Radiation therapy and autoimmune diseases can cause the ovaries to stop functioning. If the ovaries are removed by surgery, menopause will occur immediately.

What is perimenopause?

Perimenopause is the period when hormone levels start to change prior to actual menopause. It may begin anywhere from three to seven years prior to menopause. Hormone production may drop off gradually, or it may become erratic. During this time, your periods may become irregular, and you may start to experience some other menopausal symptoms.

What are the symptoms?

Some women do not experience any obvious symptoms during perimenopause, but most probably will experience at least a few symptoms. Most of these are related to changes in estrogen levels.

Hot flashes: This is probably the most well-known symptom of menopause. A hot flash is a feeling of intense heat, usually starting in the face or chest and focusing on the upper body. It may be accompanied by reddening of the skin and heavy sweating. You may feel tingling in the hands and a faster heartbeat. Sometimes a sudden chill follows the hot flash. Hot flashes rarely last longer than five minutes. They are often more common and more intense at night, and are sometimes referred to as night sweats. Hot flashes generally happen for a year or two, but some women experience them for five years or more. Although most menopausal women experience some hot flashes, only about 15% have real trouble with them.

Irregular menstruation: Periods may become farther apart, closer together, or completely unpredictable. They may be heavier, lighter, more painful, less painful. Women who have never experienced PMS may start having it; those who have it may find it gets worse before it gets better. Eventually, menstruation stops altogether.

Vaginal/Urinary tract: Thinning of the skin in the genital area is often accompanied by vaginal dryness, sensitivity, and irritation. Menopausal women often become more susceptible to urinary tract infections. Many women experience increased frequency of urination and urinary incontinence.

Skin and Hair: The skin may become thinner and drier. Some women may experience itching and increased skin sensitivity and irritability. Some begin to bruise more easily. Some women experience hair loss or hair thinning. Hair may become drier. Some women have an increase in facial hair growth.

Memory: Short-term memory problems are common, as is difficulty with concentration.

Insomnia: Difficulty sleeping, restlessness, fatigue. Often it’s the hot flashes that make it hard to get a good night’s sleep.

Emotions: Mood swings and increased irritability are common at this time. Some women experience anxiety and apprehension. Some may become depressed.

Others: Headaches (sometimes migraines), constipation, leg cramps, joint pains, bloating, breast tenderness, upset stomach, dizziness, faintness, decreased libido.

Few women will experience all of these symptoms, and most women get through menopause without too much difficulty. There are a number of treatments for the various symptoms.

How does menopause affect my health?

If you are healthy now, chances are you will remain healthy throughout menopause. There are two significant health issues that you need to be aware of:

Osteoporosis is a condition in which the bones become thin and fragile. The skeleton becomes weak and may be unable to support normal activity. There is a greatly increased chance of bone fractures. Loss of estrogen is the biggest cause of osteoporosis. Some researchers now believe that estrogen is even more significant than calcium in saving bone mass. The National Osteoporosis Foundation has information on the causes, prevention, detection and treatment of osteoporosis.

Cardiovascular diseases include atherosclerosis, high blood pressure, angina and stroke. During the childbearing years, estrogen provides a great deal of protection against cardiovascular disease. After menopause, the risk increases. For women over 50, cardiovascular disease is a much greater threat than cancer. The American Heart Association has some information about heart disease and stroke.

What can I do to stay healthy?

Exercise can be very beneficial to menopausal women. It helps reduce the risk of both osteoporosis and heart disease. Regular exercise helps to maintain strength and stamina, build muscle tone, and reduce anxiety.

Make sure you are eating a balanced diet. Your doctor may recommend vitamin supplements. Many researchers now urge women to add soy and flax to their diet, as these foods may help reduce menopausal symptoms. Many women experience weight gain at menopause, but this is not a good time for crash diets. A combination of healthy eating and reasonable exercise is the best approach.

Make sure you get regular medical checkups. If you are using herbal products for nutrition or to treat your menopausal symptoms, tell your doctor. Some herbal remedies may have interactions with each other or with other medications you are taking, so it is important that your doctor has all the right information.

If you smoke, this is an excellent time to quit. Smoking is unhealthy at any age, and it is even more dangerous for women after menopause, when the risk of heart disease increases.

What about hormone replacement therapy?

Hormone replacement therapy (HRT) is a complex and often controversial subject. There are different types and combinations of hormones, and different factors that must be taken into consideration when deciding what to do.

Information on HRT is constantly being revised. It’s been very difficult to maintain links to current articles, as they become obsolete very quickly. It seems that “experts” are becoming less and less enthusiastic about benefits vs. risks. If you are considering hormone replacement therapy, it is very important to discuss with your doctor all the latest information, and how it applies to you.

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