Menopause

Menopause refers to the time in a woman’s life, typically between the ages of 40 and 56, when the ovaries stop producing the hormones estrogen and progesterone. During this time, the woman's menstrual periods cease, which marks the end of a woman’s reproductive years.

Other Names

• Climacterium
• “Going through the Change”
• “Change of Life”
• “The Change”

Types

Typical menopause

The average age for menopause is 51 years old. However, normal menopause can happen between ages 40 to 56. The timing of when a woman goes through menopause is often related to her genetics. If her mother or sister went through menopause early or late, she also will have a higher probability of going through menopause at a similar age.

Premature menopause

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 the following 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 [OH-uh-fuh-REK-tuh-mee], 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.

Sign and Symptoms

Stages

1. Premenopause — from puberty to menopause, i.e., from a woman’s first to her last regular menstrual period. These are sometimes referred to as the “reproductive years” and a woman is noted to be “premenopausal”.
2. Perimenopause — means "near menopause". Perimenopause is a transitional stage of two to ten years before menstrual periods stop completely. It is usually experienced between ages 40 to 50. This stage of menopause is characterized by hormone fluctuations, which can cause irregular menstrual periods and some early menopausal symptoms such as hot flashes.
3. Menopause — is a natural transition in a woman's life. Menopause is the point at which estrogen and progesterone production decreases permanently to very low levels. The ovaries stop producing eggs and a woman is no longer able to get pregnant naturally.
4. Postmenopause — refers to the time in a woman’s life after menopause has occurred. It is generally believed that the postmenopausal phase begins when a women has not had a menstrual period for 12 months.^[1]

Menopause and peri-menopause affect every woman differently. Symptoms are most related to the drop in the hormone estrogen at menopause.

Common symptoms include:

• Menstrual periods may become irregular.
  • Periods that are closer together than every 21 days, periods that last for more than 7 days or new onset heavy periods with clots may be a sign of a problem. It is a good idea to consult a doctor or healthcare provider if these symptoms occur.
• Hot flashes- also known as hot flushes, are a sudden feeling of heat that rushes to the face and upper body. The skin may look blushed. Hot flashes last usually a few seconds to several minutes.
• Night sweats are problematic because they disturb a woman’s sleep. Often, women complain of drenching their pajamas from these heavy sweats.
• Trouble sleeping through the night can be related to night sweats. Menopausal women also tend to have less REM (rapid eye movement) cycles during their sleep. Women may have trouble falling asleep or may wake up in the middle of the night.
• Vaginal dryness is related to low estrogen. This can cause burning and itching symptoms and pain during intercourse. Estrogen creams and vaginal lubricants can help.
• Mood or emotional changes can be related to the drop in hormones.
• Osteoporosis, a condition where bones become weaker and may break more easily.
• Weight gain related to changes in metabolism.

Causes

Menopause happens because the woman's ovary stops producing the hormones estrogen and progesterone. Menopause is reached when a woman has gone 12 straight months without having a menstrual period.

Diagnosis

Tests for menopause

Simple blood tests for hormone levels (FSH, LH, Estradiol) can confirm if a woman is in menopause, be it early or typical menopause.

Treatments

Medications

Contraception & STDs

Women who have not yet reached twelve straight months without periods may still have a chance of getting pregnant. Therefore, these women need to continue to use contraception.

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.

Many women today find themselves in new relationships after menopause. These women are still at risk for sexually transmitted infections (STDs) and therefore, it is important that they use condoms to protect themselves.

Hormone replacement therapy (HRT)

In the past, women were encouraged by their doctors to take hormones to replace the estrogen and progesterone their bodies were losing during menopause. Taking these hormones, known as hormone replacement therapy (HRT), helped treat menopausal symptoms including hot flashes, night sweats, vaginal dryness, and bone loss.

In 2002, new research from the Women’s Health Initiative (WHI) study showed that women taking an estrogen-type hormone pill called Premarin and a progesterone type pill called Provera had an increased risk of heart attacks, stroke, blood clots, and breast cancer in postmenopause. The increased risk was found to be an increase of approximately 8 women per 10,000 women taking HRT. This was a statistically significant increased risk.

Therefore, for postmenopausal women, the U.S. Food and Drug Administration advises that HRT be used for the shortest time and at the lowest doses possible.

Once a woman reaches menopause, HRT currently is recommended only as a short-term treatment of moderate to severe symptoms such as hot flashes or night sweats. Women who have problems with vaginal dryness can try lower dose estrogen products, such as vaginal estrogen creams.

It is important to talk about the benefits and risks of using HRT with a doctor in order to decide if HRT is the right choice.

Benefits of HRT:

• Reducing hot flashes
• Treating vaginal dryness
• Slowing bone loss
• Easing mood swings and mild depressive symptoms—HRT alone is not effective in treating depression
• Improving sleep

Risks of HRT:

• Blood clots in the legs or lungs
• Heart attacks
• Strokes
• Breast cancer
• Gall bladder disease

Women should NOT use HRT for menopause if they :

• Think they are pregnant
• Have problems with abnormal 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 in the legs or lungs
• Have liver disease

Possible side effects of HRT:

• Vaginal bleeding
• Bloating
• Breast tenderness or enlargement
• Headaches
• Nausea

Holistic and alternative treatments

Some women consider alternatives to menopausal hormone therapy (traditional HRT) to ease menopausal symptoms. Some alternative therapies may have side effects or may make another drug that the patient is already taking not work as well. In addition, recent studies have shown that some herbal supplements contain unsafe levels of lead.^[2]

Common alternative therapies for menopause:

• Soy. This contains phytoestrogens (estrogen-like substances from a plant).
• Other sources of phytoestrogens, including herbs, such as black cohosh, wild yam, dong quai, and valerian root.
• Bioidentical hormone therapy

There are two main types of Bioidentical hormones:

1. Those that are FDA-approved and commercially available with a prescription.
2. Those that are mixed on an individual basis for women in compounding pharmacies. These are not FDA-approved and have not been studied in long term scientific studies.

References

1. ↑ Women's Health Initiative [1]
2. ↑ Mazzanti G, Battinelli L, Daniele C, et al. Purity control of some Chinese crude herbal drugs marketed in Italy. Food Chem Toxicol. 2008 Jun 11. Abstract

External Links

Women’s Health Initiative Web site

Recommended Guidelines for Perimenopausal and Menopausal Women. U.S. Department of Health and Human Services. Screening Tests and Immunizations Guidelines for Women

American College of Obstetricians and Gynecologists: The Menopause Years

American Academy of Family Practitioners: Menopause: What to Expect When Your Body is Changing

Mayo Clinic: Weight gain after menopause: Reverse the middle age spread

The National Institute on Aging: Hormones and Menopause

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS): Osteoporosis

National Association For Continence: Urinary Incontinence (Leakage)

FDA: Menopause

The North American Menopause Society:

• Understanding Menopause

• Menopause Basics (FAQs)

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