Menopause

What Is Menopause?

The menopause marks the time in a woman's life when her menstruation stops and she is no longer fertile (able to become pregnant).

The menopause is a normal part of like - it is a milestone, just like puberty - it is not a disease or a condition. Even though it is the time of the woman's last period, symptoms may begin many years earlier. Some women may experience symptoms for months or years afterwards.

Symptoms of menopause and peri-menopause?

Experts say that technically, the menopause is confirmed when a woman has not had a menstrual period for one year. However, the symptoms and signs of menopause generally appear well before that one-year period is over. They may include:

• Irregular periods - this is usually the first symptom; menstrual pattern changes. Some women may experience a period every two to three weeks, while others will not have one for months at a time.


• Lower fertility - during the peri-menopausal stage of a woman's life, her estrogen levels will drop significantly, lowering her chances of becoming pregnant.


• Vaginal dryness - this may be accompanied by itching and/or discomfort. It tends to happen during the peri-menopause. Some women may experience dyspareunia (pain during sex). The term vaginal atrophy refers to an inflammation of the vagina as a result of the thinning and shrinking of the tissues, as well as decreased lubrication, caused by a lack of estrogen. 
•  Approximately 30% of women experience vaginal atrophy symptoms during the early post-menopausal period, while 47% do so during the later post-menopausal period. There are cases of women who experience vaginal atrophy more than a decade after their final period.
  



• Hot flashes (UK term: hot flushes) - a sudden feeling of heat in the upper body. It may start in the face, neck or chest, and then spreads upwards or downwards (depending on where it started). The skin on the face, neck or chest may redden and become patchy, and the woman typically starts to sweat. The heart rate may suddenly increase (tachycardia), or it may become irregular or stronger than usual (palpitations). Hot flashes generally occur during the first year after a woman's final period.


• Night sweats - if the hot flashes happen in bed they are called night sweats. Most women say their hot flashes do not last more than a few minutes.


• Disturbed sleep - sleeping problems are generally caused by night sweats, but not always. Sleep disturbance may be caused by insomnia or anxiety. Difficulty falling asleep and staying asleep increase as women go through menopause.


• Urinary problems - women tend to be more susceptible urinary tract infections, such as cystitis. Having to urinate may also occur more frequently.


• Moodiness - this often goes hand-in-hand with sleep disturbance. Experts say that most mood disturbances are triggered by poor sleep.


• Problems focusing and learning - Some women may also have short-term memory problems, as well as finding it hard to concentrate on something for long. Some women may not be able to learn as well shortly before menopause compared to other stages in life.


• More fat building up in the abdomen.


• Hair loss (thinning hair).


• Loss of breast size

If left untreated, these symptoms will usually taper off gradually over a period of two to five years. However, symptoms can persist for much longer. In some cases, vaginal dryness, itching and discomfort can become chronic, and eventually get worse if left untreated.

Causes of menopause and peri-menopause?

The hormones estrogen and progesterone regulate menstruation - more specifically, estrogen regulates menstruation while progesterone is more involved with preparing the body for pregnancy.

When the ovaries start producing less of these two hormones, the peri-menopause will start. In fact, by the time a woman is in her late 30s the ovaries start producing less progesterone and estrogen. By the time she is in her 40s, the post-ovulation spike in progesterone becomes less emphasized. A woman's fertility starts to decline a long time before she may notice any menopausal or peri-menopausal symptoms.

As time passes and the ovaries produce less and less estrogen and progesterone, the ovaries eventually shut down completely and the woman no longer has any more menstrual periods. The vast majority of females experience a gradual change in menstrual activity, while some go on normally until they suddenly stop.

Some women may experience premature menopause - their ovaries fail earlier than they are supposed to (before the age of 45). Ovarian failure can occur at any age - but very rarely - and often the doctor and patient will never find out why. Some who experience ovarian failure may still have periods and some degree of fertility for a while. Premature menopause may be caused by:

• Enzyme deficiencies


• Down's syndrome


• Turner's syndrome


• Addison's disease


• Hypothyroidism


• Removal of the ovaries (bilateral oophorectomy surgery)


• Radiotherapy to the pelvic area


• Chemotherapy


• Hysterectomy surgery (the uterus - womb - is surgically removed)


• Some infections - such as mumps or TB (tuberculosis), malaria and varicella. However, in all cases risk of ovarian failure is extremely small.


• Genetic factors - scientists have been able to identify genetic factors that influence the age at which natural menopause occurs.


• Being a twin - twins are more likely to have a premature menopause.

How is menopause diagnosed?

A GP (general practitioner, primary care physician) should be able to diagnose menopause or peri-menopause if he knows the age of the patient, has information about her menstrual patterns, and receives feedback from her on her symptoms.

Apart from a blood test which can measure levels of FSH (follicle-stimulating hormone), there is no definitive test to diagnose menopause or peri-menopause. FSH blood levels rise when a woman is in the menopause. However, as FSH levels tend to fluctuate a lot during the menopause and peri-menopause, the test may provide a little data, and is not that helpful for a diagnosis. Under certain circumstance a doctor may order a blood test to determine the level of estradiol (estrogen). As hypothyroidism (underactive thyroid) can cause menopause-like symptoms, a blood test to determine the woman's level of thyroid-stimulating hormone may be recommended.

Treatment options for menopause or peri-menopause?

Only about 10% of women seek medical advice during the menopause. Many women require no treatment. However, if symptoms are affecting the woman's daily life she should see her doctor. The kind of treatment the patient should have depends on her symptoms, her medical history, as well as her own preferences. Available treatments include:

• Hormone Replacement Therapy -this is very effective for many of the symptoms that occur during the menopause, including vaginal dryness, vaginal itching, vaginal discomfort, urinary problems, bone-density loss, hot flashes and night sweats. HRT tops up the woman's levels of estrogen. However, as with many treatments, HRT has its risks and benefits:
  
  
  Benefits of HRT
  
  
  • Effectively treats many troublesome menopausal symptoms.
  • Helps prevent osteoporosis.
  • Lowers colorectal cancer risk (cancer of the colon or rectum)
  
  
  Risks of HRT
  
  
  • Raises breast cancer risk
  • Raises ovary cancer risk
  • Raises uterine cancer risk (cancer of the womb)
  • Raises coronary heart disease risk
  • Raises stroke risk
  • HRT slightly accelerates loss of brain tissue in areas important for thinking and memory among women aged 65 and over.
  Older women who take hormone therapy to relieve menopausal symptoms may get the added benefit of reduced body fat if they are physically active.
  
  Hormone therapy in early menopaus
• estrogen-progesterone hormone replacement therapy, if initiated soon after the menopause, not only improves symptoms considerably, but also improves some cardiovascular risk factors and mood.


• Low-dose antidepressants - SSRIs (selective serotonin reuptake inhibitors) have been shown to decrease menopausal hot flashes. Drugs include venlafaxine (Effexor), fluoxetine (Prozac, Sarafem), paroxetine (Paxil, others), citalopram (Celexa) and sertraline (Zoloft).


• Omega 3s - Researchers from the Universite Laval's Faculty of Medicine found that Omega-3s ease psychological distress and depressive symptoms often suffered by menopausal and peri-menopausal women.


• Gabapentin (Neurontin) - this medication is effective in treating hot flashes. It is commonly used for treating seizures (epilepsy).


• Clonidine (Catapres) - can be taken either orally as a pill or placed on the skin as a patch. It is effective in treating hot flashes. The drug is commonly used for treating high blood pressure (hypertension). However, unpleasant side-effects are common.


• Vaginal estrogen - may be applied locally using a tablet, ring or cream. This medication effectively treats vaginal dryness, discomfort during intercourse, as well as some urinary problems. A small amount of estrogen is released and absorbed by the vaginal tissue.


• Exercise - a study found that slow exercise is better for post-menopausal women than fast exercise.

Hypnosis effective for the treatment of hot flashes

Researchers reported in the journal Menopause, in October 2012, that hypnosis can reduce the symptoms of menopausal hot flashes by up to 74%. The investigators, from the school of Nursing at Indiana University, the College of Education at the University of Texas, Austin, and the Mind-Body Medicine Research Laboratory at Baylor University, carried out a randomized, controlled study to determine what the effect of hypnosis might be.

The volunteers, all with symptoms of hot flashes, were assigned to one of two groups:

• The hypnotherapy group
• The structured attention group

Those in the hypnosis group had considerably fewer bouts of hot flashes and much milder symptoms, compared to the women in the structured attention group.

Complications

After the menopause it is common for the following chronic conditions to appear. Chronic, in medical English, means long-term, continuous (as opposed to "acute").

• Cardiovascular disease - a drop in estrogen levels often goes hand-in-hand with an increased risk of cardiovascular disease. Heart disease is not exclusively a male problem, it is the main cause of death among both men and women. In order to reduce the risk of developing cardiovascular disease a woman should quit smoking, try to keep her blood pressure within normal levels, do plenty of regular exercise, sleep at least 7 hours each night, and eat a well-balanced healthy diet.


• Osteoporosis - a woman may lose bone density rapidly during the first few years after menopause. The lower a person's bone density gets the higher their risk is of developing osteoporosis. The absolute risk of a second clinical fracture is highest in the five years after any first clinical fracture for post-menopausal women.


• Urinary incontinence - the menopause causes the tissues of the vagina and urethra to lose their elasticity, which can result in frequent, sudden, strong urges to urinate, followed by urge incontinence (involuntary loss of urine). Stress incontinence may also become a problem - urinating involuntarily after coughing, sneezing, laughing, lifting something, or suddenly jerking the body as may happen when we temporarily lose our balance.


• Low libido - this is probably linked to disturbed sleep, depression symptoms, and night sweats, a study found.


• Overweight/obesity - during the menopausal transition women are much more susceptible to weight gain. Experts say women may need to consume about 200 to 400 fewer calories each day just to prevent weight gain - or burn of that number of calories each day with extra exercise. The chances of becoming obese rises significantly after the menopause.


• Breast cancer - women are at a higher risk of breast cancer after the menopause. Regular exercise after menopause significantly reduces breast cancer risk.

Self Assistance

Unless your symptoms are severe, you may find that some changes in your lifestyle and diet are all you need to deal with the symptoms.

• Hot flashes and night sweats
  
  
  • Do plenty of exercise.
  • Avoid wearing tight clothing.
  • Make sure the bedroom is not hot.
  • Try to reduce your levels of stress.
  • Remember the following commonly trigger symptoms for susceptible people: spicy food, caffeine, smoking, and alcohol.


• Sleep disturbance
  
  
  • Exercise regularly. However, do not exercise too late during the day. Exercising too late may keep you awake longer.
  • Go to bed and get up at the same time each day - even during weekends.
  • Cut out all drinks and foods that contain caffeine.
  • Learn how to do deep breathing, guided imagery, and progressive muscle relaxation.


• Moodiness
  
  
  • Make sure you do not get tired - get plenty of rest.
  • Do regular exercise. If you can, do strenuous exercise - check with your doctor whether this is OK for you.
  • Practice yoga. Make sure you have a well qualified trainer.


• Vaginal discomfort and dryness
  
  
  • Get some OTC (over the counter) water-based vaginal lubricants or moisturizers.
  • Stay sexually active.
• Urinary incontinence
  
  Practice pelvic floor muscle exercises - Kegel exercises. If you practice three or four times a day you will most probably notice a difference after a few weeks. This review of studies explains that women suffering from urinary incontinence can benefit from pelvic floor muscle training.