Menopause Basics

Overview

Menopause is a natural biologic event, not a disease or an "estrogen deficiency disease." Menopause represents the permanent cessation of menses resulting from loss of ovarian follicular function. Menopause is also a psychosocial passage. At menopause, the decline in ovarian hormones (particularly estrogen) may result in short-term, unpleasant effects such as hot flushes that adversely affect quality of life, and may increase the risk of osteoporosis..

Menopause happens to all women, but affects each woman uniquely. For some, the end of fertility (and the end of concerns about contraception and menstrual periods) brings a sense of freedom. Menopause is a bridge to a part of life when many women report feeling more confident, empowered, involved, and energized than in their younger years. For some women, however, menopause - coupled with midlife emotional and social crises - can contribute to serious health problems.

One thing is true for all women: Menopause is a signal to start - or continue - a good health program. Clinicians are urged to utilize an individualized approach to "menopause management," because no intervention is appropriate for every woman and each option has a risk/benefit profile unique to each woman.

Because of current population shifts, a woman's health after menopause has assumed greater importance than ever before. The ideal goal is that of maximum vigor until death. Although some decline is unavoidable, much of what is considered as normal aging can be modified with lifestyle and pharmacologic interventions. Menopause is a time for women to evaluate their health and lifestyle practices.

Menopause can occur "naturally" (ie: spontaneously) or "induced" through a medical intervention (ie, surgery, chemotherapy, or pelvic radiation therapy).

Facts about menopause

Menopause is the medical term for the end of a woman's menstrual periods. It is a natural part of aging, and occurs when the ovaries stop making hormones called estrogens. This causes estrogen levels to drop, and leads to the end of monthly menstual periods. This usually happens between the ages of 45 and 58, but it can happen earlier. Menopause can also occur when the ovaries are surgically removed or stop functioning for any other reason.

Low estrogen levels are linked to some uncomfortable symptoms in many women. The most common and easy to recognize symptom is hot flushes - sudden intense waves of heat and sweating. Some women find that these hot flushes disrupt their sleep, and others report mood changes. Other symptoms may include joint and body ache and dryness of the vagina. Because of the changes in the urinary tract and vagina, some women may have discomfort or pain during sexual intercourse. Many women also notice changes in their skin and hair during menopause.

The period of time leading up to menopause is termed the Menopause Transition. This was previously called the Perimenopause. The early menopause transition can begin 5 to 6 years prior to menopause. During this time periods become slightly more irregular with cycles changing in that they often occur up to 7 days earlier or later than previously. About 1 to 2 years prior to menopause a woman enters the late menopause transion. Periods are often missed during this time. During both of these phases, hot flushes are often present. In the early transition levels of estrogen and progesterone are often raised giving rise to symptoms such as breat tenderness, bloating, fluid retension and premenstrual mood swings. As in the early transition, hormone levels are often raised, hormone replacement therapy is not indicated as it often worsens symptoms such as breast tenderness and fluid retension. In the late transition, estrogen levels are usually low and at this time estrogen or estrogen/progestn therapy can provide relief from symptoms.


Understanding Estrogen & Progesterone

Estrogen is known as a 'female hormone' because it plays a key role in shaping the female body and preparing it for uniquely female functions such as pregnancy. For example, estrogen is vital for the development of breasts and hips. In addition, the vagina, uterus, and other female organs depend on the presence of estrogen in the body to mature.


Together with progesterone, another female hormone made by the ovaries, estrogen regulates the changes that occur with each monthly period and prepares the uterus for pregnancy. Prior to menopause, more than 90% of the estrogen in a woman's body is made by the ovaries. Other organs (including the adrenal glands, liver, and kidneys) also make small amounts of estrogen. That's why women continue to have low levels of estrogen after menopause. Because fat cells can also make small amounts of estrogen, women who are overweight when they are going through menopause may have fewer problems with hot flushes and osteoporosis (both of which are related to lack of estrogen).

Some of the other important benefits of estrogen become apparent when estrogen levels decline after menopause. For instance, estrogen stimulates skeletal growth and helps maintain healthy bones.Estrogen may also affect a woman's sexual desire.

Progesterone is the second most important female hormone. Like estrogen, most progesterone is made by the ovaries, with a smaller amount made by the adrenal glands. The job of progesterone is to:

Symptoms

About 75% of women report some troublesome symptoms during menopause, but the severity and frequency of symptoms varies from woman to woman. The most common early symptoms are hot flushes, night sweats and vaginal dryness.

Irregular bleeding

As mentioned above, the period of time leading up to menopause is often characterized by irregular periods. In fact, changes such as shorter or longer periods, heavier or lighter menstrual bleeding, and varying lengths of time between periods may be a sign that menopause is near.

You should talk to a physician if:

Hot flushes

Factors that may be linked to hot flushes:

 

Hot flushes are the classic sign of menopause, as well as the most common reason for seeking treatment. A hot flush produces a sudden sensation of warmth or even intense heat that spreads over various parts of the body, especially the chest, face, and head. Flushing and sweating usually occur as well, followed by a chill. Some women feel their heart beating very fast or hard and feel anxious.

These flushes last anywhere from a few seconds to several minutes. How often they occur varies from woman to woman. Many women experience most of their hot flushes in the first 2 years after menopause, and find that the hot flushes gradually lessen with time. However, some women have hot flushes for several years before menopause, and some have them for 10, 20, or even 40 years or longer after menopause.

Hot flushes can affect a woman's social life and work. Also, hot flushes that occur during the night can disrupt sleep. In fact, some women report that their bedsheets become dampened or even soaked with sweat when they have a hot flush during the night.

Vaginal thinning

Estrogen plays a key role in maintaining the function of a woman's vagina and surrounding tissues, uterus, urinary bladder, and urethra (the organ through which urine is passed from the bladder). After menopause, all of these organs may weaken or shrink. When these changes occur in the bladder and urethra, they can lead to the involuntary leakage of urine, infection, or painful urination.

A thinning of the tissue lining the vagina may lead to pain during intercourse. Vaginal dryness can also occur, as may itching or irritation. Although few women experience serious problems with vaginal dryness and thinning right after menopause, both dryness and thinning continue to occur over time. Some doctors estimate that at least half of all women older than 60 years have some degree of vaginal dryness. Regular sexual intercourse can help to keep the vagina moist and toned.

Links between mood, menopause, and sexual function

Many women complain of loss of memory during the menopausal years. Part of this may be due to the other symptoms such as flushes and sleep disturbances. In these situations hormone replacement therapy may be of benefit.

Depression may also be more likely in the years immediately before menopause. However, it is unclear whether depression is linked to low levels of estrogen or to the many changes women face during their 40s and 50s (such as career or marriage pressures, or care of children or aging parents). The tiredness consequent to the sleep disturbances as well as other suptoms such as joint pain and flushes may also contribute to these mood problems. The first line treatment of true depression should be by means of counselling and the use, if neccessary of antidepressant medications. However estrogen therapy has been shown to aid the action of certain antidepressant medications.

Many women complain of lack of libido during the menopause. There are many factors that may contribute to to this problem. These include relationship and work issues. However, symptoms such as tiredness and vaginal dryness will contribute to this problem and in these instances hormone replacement therapy may be of benefit. In women who have had their ovaries surgically removed, there is a sudden drop of testosterone levels and this can dramatically reduce libido. Carefully administered testerone may be of benefit in this situation.

Diagnosis

Menopause is usually diagnosed after the doctor reviews a woman's medical history and performs a physical examination. The doctor may also order blood tests to make sure the symptoms are related to menopause and to decide what therapy, if any, might be most appropriate.


Health Changes After Menopause

 

Osteoporosis

Factors that increase the risk for osteoporosis

Osteoporosis is the medical term for thinning of the bones. Thin bones become weaker and break easily, with the bones of the spine, wrists, and hips most prone to fracture. Although bones naturally weaken with age in both men and women starting at about age 40, women lose bone more rapidly after menopause.

Using estrogen after menopause can slow the rate of bone thinning and may prevent bones from breaking. Because estrogen use has some risks, only women who are likely to develop osteoporosis should use estrogens for prevention. If you have some of the factors that are listed below, or are concerned about your risk for osteoporosis, talk to your doctor. He or she can help you to evaluate your risk and decide whether estrogen therapy is right for you.

Making sure to get enough calcium in your diet can help strengthen your bones. Calcium is naturally found in many foods, including dairy products, and may also be added to a food (for instance, some orange juices now have calcium added). Calcium tablets are another good way to add to calcium to your diet. The goal should be to reach a total daily intake of 1000 milligrams per day before menopause or 1500 milligrams per day after menopause. Regular weight-bearing exercise, like walking, may also help prevent osteoporosis.

Heart disease

The rate of heart disease rises considerably in women after menopause. Because many people think of heart disease as a "man's problem," it may be surprising to know that heart disease is the leading cause of death among women.

Risk factors for heart disease in women (as well as men) include:

Estrogen replacement therapy can help to decrease cholesterol levels. It has however not been shown that it can decrease the incidence of heart disease. Some studies have suggested that in older women (older than 60 years, estrogen replacement may increase the risk of strokes.

Readers are encouraged to access the other articles on our website for more information on Hormone Replacement Therapy and other altenatives for menopausal management.