What Is Menopause?

What is menopause?

Menopause is defined as the state of an absence of menstrual periods for 12 months. The menopausal transition starts with varying menstrual cycle ength and ends with the final menstrual period. Perimenopause means "the time around menopause" and is often used to refer to the menopausal transitional period. It is not officially a medical term, but is sometimes used to explain certain aspects of the menopause transition in lay terms. Postmenopause is the entire period of time that comes after the last menstrual period.

Menopause is the time in a woman's life when the function of the ovaries ceases. The ovary (female gonad), is one of a pair of reproductive glands in women. They are located in the pelvis, one on each side of the uterus. Each ovary is about the size and shape of an almond. The ovaries produce eggs (ova) and female hormones such as estrogen. During each monthly menstrual cycle, an egg is released from one ovary. The egg travels from the ovary through a Fallopian tube to the uterus.

The ovaries are the main source of female hormones, which control the development of female body characteristics such as the breasts, body shape, and body hair. The hormones also regulate the menstrual cycle and pregnancy. Estrogens also protect the bone. Therefore, a woman can develop osteoporosis (thinning of bone) later in life when her ovaries do not produce adequate estrogen.

Perimenopause is different for each woman. Scientists are still trying to identify all the factors that initiate and influence this transition period

Menopause is a natural event that normally occurs in women age 45 - 55.

Causes, incidence, and risk factors

During menopause, a woman's ovaries stop making eggs and they produce less estrogen &  and progesterone. Changes in these hormones cause menopause symptoms. Periods occur less often and eventually stop. Sometimes this happens suddenly. But most of the time, periods slowly stop over time.

Menopause is complete when you have not had a period for 1 year. This is called postmenopause. Women who are postmenopausal can no longer get pregnant.

Surgical menopause is when medical treatments cause a drop in estrogen. This can happen if your ovaries are removed or if you receive chemotherapy or hormone therapy for breast cancer.

 {ESTEROGENS are female hormones. They are produced by the body and are necessary for the normal sexual development of the female and for the regulation of the menstrual cycle during the childbearing years.The ovaries begin to produce less estrogen after menopause (the change of life). This medicine is prescribed to make up for the lower amount of estrogen. Estrogens help relieve signs of menopause, such as hot flashes and unusual sweating, chills, faintness, or dizziness.

Estrogens are prescribed for several reasons:

·         To provide additional hormone when the body does not produce enough of its own, such as during menopause or when female puberty (development of female sexual organs) does not occur on time. Other conditions include a genital skin condition (vulvar atrophy), inflammation of the vagina (atrophic vaginitis), or ovary problems (female hypogonadism or failure or removal of both ovaries).

·         To help prevent weakening of bones (osteoporosis) in women past menopause.

·         In the treatment of selected cases of breast cancer in men and women.

·         In the treatment of cancer of the prostate in men.

Estrogens may also be used for other conditions as determined by your doctor.

There is no medical evidence to support the belief that the use of estrogens will keep the patient feeling young, keep the skin soft, or delay the appearance of wrinkles. Nor has it been proven that the use of estrogens during menopause will relieve emotional and nervous symptoms, unless these symptoms are caused by other menopausal symptoms, such as hot flashes or hot flushes. Estrogens are available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, estrogen is used in certain patients with the following medical conditions:

·         Gender identity disorder, male-to-female transsexualism (person who is born as a man but adapts to a woman's lifestyle, sees himself as a woman, and feels like a woman instead of a man.

·         Osteoporosis caused by lack of estrogen before menopause.

·         Turner's syndrome (a genetic disorder).

PROGESTERONE : There is little good evidence for treating premenstrual syndrome with progesterone. Five per cent or more of women experience symptoms, severe enough to damage work and relationships, only in the days leading to their menstrual periods. Blood progesterone levels usually rise after ovulation and fall again before menstruation. It has been suggested that premenstrual syndrome (PMS) might have been caused by too little progesterone or falling levels.

This review found some evidence for relief with progesterone but trials differed in route of administration, dose, duration of treatment and selection of women taking part. Outcomes also differed. The studies had flaws in methods or in handling outcome data or both.

Adverse effects which may or may not have been the result of the treatment were generally mild.Further research would be needed to test claims for the effectiveness of higher doses of progesterone. They are neither refuted nor borne out as yet. Using each woman's own symptoms to select participants and to judge treatment effects would be more accurate than checklists of largely irrelevant symptoms. Knowing how many women had fewer days with symptoms, fewer or milder symptoms, or the converse, would be more valuable than the calculations based on subjective data for groups of women. }

Symptoms

Symptoms vary from woman to woman. They may last 5 or more years. Some women may have worse symptoms than others. Symptoms of surgical menopause can be more severe and start more suddenly.

The first thing you may notice is that your periods start to change. They might occur more often or less often. Some women might get their period every 3 weeks. This might last for 1 - 3 years before the periods completely stop.

Common symptoms of menopause include:

·         Menstrual periods that occur less often and eventually stop

·         Heart pounding or racing

·         Hot flashes, usually worst during the first 1 - 2 years

·         Night sweats

·         Skin flushing

·         Sleeping problems (insomnia)

Other symptoms of menopause may include:

·         Decreased interest in sex, possibly decreased response to sexual stimulation

·         Forgetfulness (in some women)

·         Headaches

·         Mood swings including irritability, depression, and anxiety

·         Urine leakage

·         Vaginal dryness and painful sexual intercourse

·         Vaginal infections

·         Joint aches and pains

·         Irregular heartbeat (palpitations)

Signs and tests

Blood and urine tests can be used to look for changes in hormone levels. Test results can help your doctor determine if you are close to menopause or if you have already gone through menopause.

Your health care provider will perform a pelvic exam. Decreased estrogen can cause changes in the lining of the vagina.

Bone loss increases during the first few years after your last period. Your doctor may order a bone density test to look for bone loss related to osteoporosis.

Treatment

Treatment for menopause depends on many things, including how bad your symptoms are, your overall health, and your preference. It may include lifestyle changes or hormone therapy.

HORMONE THERAPY

Hormone therapy may help if you have severe hot flashes, night sweats, mood issues, or vaginal dryness. Hormone therapy is treatment with estrogen and, sometimes, progesterone.

Talk to your doctor about the benefits and risks of hormone therapy. Your doctor should be aware of your entire medical history before prescribing hormone therapy (HT). Learn about options that do not involve taking hormones.

Several major studies have questioned the health benefits and risks of hormone therapy, including the risk of developing breast cancer, heart attacks, strokes, and blood clots.

Current guidelines support the use of HT for the treatment of hot flashes. Specific recommendations:

·         HT may be started in women who have recently entered menopause.

·         HT should not be used in women who started menopause many years ago, except for estrogen vaginal creams.

·         The medicine should not be used for longer than 5 years.

·         Women taking HT have a low risk for stroke, heart disease, blood clots, or breast cancer.

To reduce the risks of estrogen therapy, your doctor may recommend:

·         A lower dose of estrogen or a different estrogen preparation (for instance, a vaginal cream or skin patch rather than a pill)

·         Frequent and regular pelvic exams and Pap smears to detect problems as early as possible

·         Frequent and regular physical exams, including breast exams and mammograms

If you have a uterus and decide to take estrogen, you should also take progesterone to prevent cancer of the lining of the uterus (endometrial cancer). If you do not have a uterus, you do not need progesterone.

ALTERNATIVES TO HORMONE THERAPY

There are other medicines available to help with mood swings, hot flashes, and other symptoms. These include:

·         Antidepressants, including paroxetine (Paxil), venlafaxine (Effexor), bupropion (Wellbutrin), and fluoxetine (Prozac)

·         A blood pressure medicine called clonidine

·         Gabapentin, a seizure drug that also helps reduce hot flashes

DIET AND LIFESTYLE CHANGES

Hormones are not always needed to reduce symptoms of menopause. There are many steps you can take to reduce symptoms.

Diet changes:

·         Avoid caffeine, alcohol, and spicy foods.

·         Eat soy foods. Soy contains estrogen.

·         Get plenty of calcium and vitamin D in food or supplements.

Exercise and relaxation techniques:

·         Get plenty of exercise.

·         Do Kegal exercises every day. They strengthen the muscles of your vagina and pelvis.

·         Practice slow, deep breathing whenever a hot flash starts to come on. Try taking six breaths a minute.

·         Try yoga, tai chi, or meditation.

Other tips:

·         Dress lightly and in layers.

·         Keep having sex.

·         Use water-based lubricants or a vaginal moisturizer during sex.

·         See an acupuncture specialist.

Complications

Some women have vaginal bleeding after menopause. This is often nothing to worry about. However, you should tell your health care provider if this occurs. It may be an early sign of other health problems, including cancer.

Decreased estrogen levels have been linked with some long-term effects, including:

·         Bone loss and osteoporosis in some women

·         Changes in cholesterol levels and greater risk of heart disease

Calling your doctor

Call doctor if:

·         You are spotting blood between periods

·         You have had 12 consecutive months with no period and suddenly vaginal bleeding or spotting begins again, even if it is a very small amount

Prevention

Menopause is a natural and expected part of a woman's development and does not need to be prevented. You can reduce your risk of long-term problems such as osteoporosis and heart disease by taking the following steps:

·         Control your blood pressure, cholesterol, and other risk factors for heart disease.

·         Do NOT smoke. Cigarette use can cause early menopause.

·         Eat a low-fat diet.

·         Get regular exercise. Resistance exercises help strengthen your bones and improve your balance.

·         If you show early signs of bone loss or have a strong family history of osteoporosis, talk to your doctor about medications that can help stop further weakening.

·         Take calcium and vitamin D.

10 Questions To Ask Your Doctor About Menopause

1. Note: Recommended : you print these 10 questions to use as a reference for your consultation with your doctor.

1. Could my symptoms be due to a condition other than menopause? (Be ready with a diary of symptoms - the character, frequency, duration, intensity, triggers, etc.)
2. What are the medications that I might consider to control my menopause symptoms? Are there lifestyle or other modifications I can make to help alleviate the symptoms?
3. If I choose to use hormone therapy, what are the advantages and disadvantages of the various routes of administration (pill, patch, cream, vaginal, etc.)?
4. What are the side effects of hormone therapy, and how does my individual health/family history affect my decision to take hormone therapy? What are the risks?
5. If I choose a non-hormonal prescription medication that is not FDA-approved for menopause symptoms (such as a selective serotonin reuptake inhibitor or SSRI medication), what is the scientific evidence that it works?
6. How do the side effects differ among the various non-hormonal prescription medications commonly used for menopause symptoms?
7. Given that long-term safety is not yet established for any of the herbal or food supplement (over-the-counter) remedies, are any suggested to be effective by reliable scientific trials?
8. What are the herbal and/or food supplement remedies that women commonly buy to treat menopause symptoms (for example, hot flashes,painful sexual intercourse), and what are the side effects of these remedies? What are the potential risks or dangers of these treatments?
9. Which herbal or food supplements might interact with my current medications?
10. Are there over-the-counter menopause remedies that I have to discontinue prior to undergoing any surgery or procedure?