Menopause
Definition
Menopause is the
transition period in a woman's life when her ovaries stop producing
eggs, her body produces less estrogen and progesterone, and menstruation
becomes less frequent, eventually stopping altogether.
Symptoms
In some women,
menstrual flow comes to a sudden halt. More commonly, it slowly stops
over time. During this time, the menstrual periods generally become
either more closely or more widely spaced. This irregularity may last
for 1 - 3 years before menstruation finally ends completely. Before this
the cycle length may shorten to as little as every 3 weeks.
Common
symptoms of menopause include:
- Heart pounding or racing
- Hot
flashes
- 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)
- Irregular menstrual periods
- Mood swings
including irritability, depression, and anxiety
- Urine leakage
- Vaginal
dryness and painful sexual intercourse
- Vaginal infections
- Joint
aches and pains
- Irregular heartbeat (palpitations)
Causes & Risks
Menopause
is a natural event that normally occurs between the ages of 45 and 55.
Once
menopause is complete (called postmenopause) and you have not had a
period for 1 year, you are no longer at risk of becoming pregnant.
The
symptoms of menopause are caused by changes in estrogen and
progesterone levels. The ovaries make less of these hormones over time.
The specific symptoms and how significant (mild, moderate, or severe)
they are varies from woman to woman.
A gradual decrease of
estrogen generally allows your body to slowly adjust to the hormonal
changes. Hot flashes and sweats are at their worst for the first 1 - 2
years. Menopause may last 5 or more years.
Estrogen levels may
drop suddenly after some medical treatments, as is seen when the ovaries
are removed surgically (called surgical menopause). Chemotherapy and
anti-estrogen treatment for breast cancer are other examples. Symptoms
can be more severe and start more suddenly in these circumstances.
As
a result of the fall in hormone levels, changes occur in the entire
female reproductive system. The vaginal walls become less elastic and
thinner. The vagina becomes shorter. Lubricating secretions from the
vagina become watery. The outside genital tissue thins. This is called
atrophy of the labia.
Tests & Diagnostics
Blood
and urine tests can be used to measure changes in hormone levels that
may signal when a woman is close to menopause or has already gone
through menopause. Examples of these tests include:
A
pelvic exam may indicate changes in the vaginal lining caused by
declining estrogen levels. The doctor may perform a bone density test to
screen for low bone density levels that occur with osteoporosis.
Treatments
Treatment with
hormones may be helpful if you have severe symptoms such as hot flashes,
night sweats, mood issues, or vaginal dryness.
Discuss the
decision to take hormones thoroughly with your doctor, weighing your
risks against any possible benefits. Pay careful attention to the many
options currently available to you that do not involve taking hormones.
Every woman is different. Your doctor should be aware of your entire
medical history when considering prescribing hormone therapy.
If
you have a uterus and decide to take estrogen, you must also take
progesterone to prevent endometrial cancer (cancer of the lining of the
uterus). If you do not have a uterus, progesterone is not necessary.
HORMONE
THERAPY
Several major studies have questioned the health benefits
and risks of hormone replacement 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:
- T may be started in women who have
recently entered menopause.
- HRT should not be used in women who
started menopause many years ago.
- The medicine should not be
used for longer than 5 years.
- Women taking HT should have a
baseline low risk for stroke, heart disease, blood clots, or breast
cancer.
To reduce the risks of estrogen therapy and still
gain the benefits of the treatment, your doctor may recommend:
- Using
estrogen or progesterone regimens that do not contain the form of
progesterone used in the study
- Using a lower dose of estrogen or
a different estrogen preparation (for instance, a vaginal cream rather
than a pill)
- Having frequent and regular pelvic exams and Pap
smears to detect problems as early as possible
- Having frequent
and regular physical exams, including breast exams and mammograms
See
also: Hormone therapy for more information about taking hormone
therapy.
ALTERNATIVES TO HT
There are some medications
available to help with mood swings, hot flashes, and other symptoms.
These include low doses of antidepressants such as paroxetine (Paxil),
venlafaxine (Effexor), bupropion (Wellbutrin), and fluoxetine (Prozac),
or clonidine, which is normally used to control high blood pressure.
Gabapentin is also effective for reducing hot flashes.
LIFESTYLE
CHANGES
The good news is that you can take many steps to reduce
your symptoms without taking hormones:
- Avoid caffeine,
alcohol, and spicy foods
- Dress lightly and in layers
- Eat
soy foods
- Get adequate calcium and vitamin D in food and/or
supplements
- Get plenty of exercise
- Perform Kegel
exercises daily to strengthen the muscles of your vagina and pelvis
- Practice
slow, deep breathing whenever a hot flash starts to come on (try taking
six breaths per minute)
- Remain sexually active
- See an
acupuncture specialist
- Try relaxation techniques such as yoga,
tai chi, or meditation
- Use water-based lubricants during sexual
intercourse
Drugs
Women who are still having
periods but who have annoying menopausal symptoms may take low-dose
birth control pills to ease the problems; this treatment has been
approved by the FDA for perimenopausal symptoms in women under age 55.
HRT uses lower doses of estrogen, however.
Supplements
Herbs have
been used to relieve menopausal symptoms for centuries. Women who choose
to take herbs for menopausal symptoms should learn as much as possible
about herbs and work with a qualified practitioner (an herbalist, a
traditional Chinese doctor, or a naturopathic physician).
The following list of herbs include those that herbalists recommend
to treat menopausal symptoms:
- black cohosh (Cimicifuga racemosa): shown to reduce
hot flashes, other menstrual complaints at a recommended dose of 20 mg
twice daily
- black currant: breast tenderness
- chaste tree/chasteberry (Vitex agnus-castus): hot flashes,
excessive menstrual bleeding, moodiness
- chickweed (Stellaria media): hot flashes
- evening primrose oil (Oenothera biennis): mood swings,
irritability, breast tenderness
- fennel (Foeniculum vulgare): hot flashes, digestive gas,
bloating
- flaxseed (linseed): excessive menstrual bleeding, breast tenderness,
and other symptoms, including dry skin and vaginal dryness
- ginkgo (Ginkgo biloba): memory problems
- ginseng (Panax ginseng): hot flashes, fatigue, vaginal
thinning
- hawthorn (Crataegus laevigata): memory problems, fuzzy
thinking
- horsetail (Equisetum arvense): osteoporosis
- lady's mantle: excessive menstrual bleeding
- Licorice (Glycyrrhiza glabra) root: general menopausal
symptoms
- Mexican wild yam (Dioscorea villosa) root: vaginal
dryness, hot flashes, general menopause symptoms
- motherwort (Leonurus cardiaca): night sweats, hot flashes
- oat (Avena sativa) straw: mood swings, anxiety
- passionflower (Passiflora incarnata): insomnia, pain
- raspberry leaf: normalizes hormonal system
- sage (Salvia officinalis): mood swings, headaches, night
sweats
- skullcap (Scutellaria lateriflora): insomnia
- sesame oil: vaginal dryness (applied topically)
- valerian (Valeriana officinalis): insomnia
- violet (Viola odorata): hot flashes.
Alternative Therapies
Homeopathic
remedies for menopausal symptoms have been clinically successful. For
best results, the patient should consult a homeopathic physician.
However, the following remedies can be tried to alleviate specific
groups of symptoms:
- lachesis: hot flashes, irritability, talkativeness, tightness around
abdomen, dizziness, fainting
- sepia: bleeding between periods, chilliness, tearfulness, withdrawal
from loved ones, sinking feeling in stomach
- pulsatilla: tearfulness, thirstless, feels better with others,
avoids heat, hot flashes, varicose veins, hemorrhoids
- sulfur: philosophical personality, feeling hot, itching and
burning of vagina and rectum
- lycopodium: low self esteem, bloated after eating, infrequent
menstruation, low blood sugar, weak digestion, belching
- Argentum nitricum: gas, indigestion, craving for
sweets and chocolate, panic attacks, fear of crossing bridges
- Magnesium phosphoricum: severe cramping
- transitional formula: hot flashes, night sweats, insomnia,
skin-crawling sensation
- women's formula: perimenopause, PMS, irregular cycles, infertility,
absent or excessive bleeding, menopausal discomfort
- vital formula: anxiety, headaches, palpitations, PMS, mood swings
Complications
Postmenopausal
bleeding may occur. This bleeding is often nothing to worry about.
However, your health care provider should always check any
postmenopausal bleeding, because it may be an early sign of other
problems, including cancer.
Decreased estrogen levels are also
associated with the following long-term effects:
- Bone loss
and eventual osteoporosis in some women
- Changes in cholesterol
levels and greater risk of heart disease
Prevention
Menopause is a
natural and expected part of a woman's development and does not need to
be prevented. However, there are ways to reduce or eliminate some of the
symptoms of menopause.
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, talk to your
doctor about medications that can help stop further weakening.
- Take
calcium and vitamin D.