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What is Menopause?
Menopause is the medical word for the transition period in a woman’s life when her ovaries stop producing eggs, menstrual activity decreases and eventually ceases, and her body decreases the production of the female hormones, estrogen, and progesterone. For most women, their last period takes place when they are between the ages of 40 and 50, but it can happen as late as age 60.
A woman is said to have reached menopause when she has gone six to 12 months without a period. However, the term "menopause" is often used to describe the entire period of change that comes before and after the actual date of menopause. In some women, menstrual activity stops suddenly, but usually it tapers off, both in amount and duration of flow, and frequently the menstrual periods become more closely or more widely spaced. This irregularity may last for two or three years before menstruation finally ceases.
Menopause rarely involves any disease or disorder. Instead, it is a completely natural stage in life – one that women can prepare for with knowledge and confidence.
The Rest of Life
Understanding both the physical and psychological aspects of menopause helps every woman prepare. Menopause sets the stage for the last portion of a woman's life, a portion that – while different from earlier parts – may be very rewarding. Menopause brings with it the time to look at yourself, evaluating the way you want to look, the new choices you want to make, and the new challenges you wish to explore. It's an opportunity to find strengths and freedoms that you have never before experienced. Many women report an increase in energy, more self-confidence, and a better attitude.
Early Help
Many women go to see their gynecologist after age 35 if their menstrual periods become irregular. More than just satisfying a woman's curiosity about whether or not she is entering menopause, a visit to a physician can rule out more serious causes of the irregular cycle. A biopsy of endometrial tissue can rule out cancer, and a laboratory test can reveal if the body is decreasing its production of hormones.
Early knowledge gives a woman time to talk to her doctor about taking hormone replacement therapy (HRT). It also gives her the chance to take steps to prevent osteoporosis.
Signs and Symptoms
Lower estrogen levels produce the symptoms of menopause. Most women have some irregular periods before they stop completely, but about 25 percent of women notice no other changes at menopause. Another 50 percent notice minor physical or mental changes.
The other 25 percent have definite symptoms, including:
- Hot flashes – intense waves of heat in the face, neck or chest; they may be as infrequent as once a week or as often as 10 times an hour
- Night sweats, similar to hot flashes but happening only at night
- Vaginal inelasticity and dryness
- Weight gain
- Skin changes, including brown spots and tingling sensations on the skin
Osteoporosis Risk
While menopause itself is not a disease, the drop-off in how much estrogen the body produces can lead to a very real disease: osteoporosis. Nearly half of all American women have some bone loss by age 45. Osteoporosis is closely related to menopause because the loss of estrogen production can lead to a decrease in the body's bone mass. As a result, bones become more brittle and may fracture more easily.
Factors other than menopause may contribute to a woman's developing osteoporosis. A woman's family health history, amount of exercise, and calcium intake also influence it. Women who smoke are more at risk for osteoporosis than those who do not, Caucasian and Asian women are at greater risk than African-American women, and very thin and childless women are also at greater risk. When a woman knows early that she is entering menopause, she has time to explore options with her doctor to help prevent further loss of bone mass.
Hormone Replacement Therapy
Hormone replacement therapy (HRT) was, for many years, a common treatment for menopause symptoms. HRT is a combination of estrogen and progestin (a synthetic form of progesterone) taken to relieve the symptoms of menopause.
Until recently, many doctors believed that HRT might be beneficial for reducing the risk of heart disease and bone fractures caused by osteoporosis (thinning of the bones), in addition to treating menopausal symptoms.
The results of a major study (the Women's Health Initiative or WHI), however, have led to a revision of recommendations regarding HRT.
According to the National Institutes of Health (NIH), the WHI enrolled 161,809 women between the ages of 50 - 79 in 40 different medical centers across the country. Part of the study was intended to examine the health benefits and the risks of hormone replacement therapy, including the risks of breast cancer, heart attacks, strokes, and blood clots.
In July 2002, one component of the WHI, which studied the use of estrogen and progestin in women who had a uterus, was stopped early because the health risks exceeded the health benefits.
The WHI study showed that women taking estrogen plus progestin experienced an increase in breast cancer cases, as well as increases in heart attacks, strokes, and blood clots. Results released in October 2003 led to the recommendation that HRT should not be prescribed to prevent or treat osteoporosis for most women. Its bone-strengthening benefits don't outweigh the increased risks of heart disease, breast cancer, stroke and blood clots in the lungs.
Talk to Your Doctor
Women taking HRT should consult with their doctors before stopping the drugs abruptly. A variety of alternative drugs for osteoporosis are on the market, and some women may still want to consider HRT for short-term use to reduce symptoms of menopause (vaginal dryness, hot flashes).
To reduce the risks of estrogen replacement therapy and still gain the benefits of the treatment, the NIH says physicians may recommend:
- Using estrogen/progesterone regimens that do not contain medroxyprogesterone acetate
- 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
- Until more is known about ERT and HRT, women should weigh the benefits and the possible risks against the symptoms being experienced. A thorough discussion with a physician is needed.
The NIH lists the following alternatives to HRT for menopause symptoms:
- Dressing lightly and in layers; avoiding caffeine, alcohol, and spicy foods.
- Paced deep breathing. Practice taking six slow deep breaths per minute and do that breathing pattern whenever a hot flash is starting to come on.
- Acupuncture and relaxation techniques.
- Low doses of antidepressants such as paroxetine (Paxil), venlafaxine (Effexor) and fluoxetine (Prozac)
- Clonidine, a medication also used to control blood pressure
Trials of black cohosh and soy have not consistently found these supplements to be useful.
Taking hormone therapy is one of the most important health decisions a woman in mid-life can make. Making an informed decision in conjunction with her doctor is the best course for a woman to take.
Last Updated: May 25, 2004
References: Medline Plus
DrKoop.com
Medscape
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