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In menopausal
woman, the most common symptoms are:
Hot Flashes
Mood Swings
Forgetfulness
Vaginal Dryness
Irritability |
Menopause
Menopause is an important time in a woman's life. Her body is going
through changes that can affect her social life, her feelings about
herself, and her functioning at work. In the past, menopause was often
surrounded by misconceptions and myths. Now, it is recognized that
menopause is a natural step in the process of aging. Contrary to the
old-fashioned view that life is all downhill after menopause, many women
today find that the years after menopause offer new discoveries and
fresh challenges.
General Introduction
Today, medical advances have resulted in a wide range of health care
choices that can enhance quality of life during menopause and the
decades afterward. It is vital for women to know that menopause itself
carries no serious health risks. However, the chance for heart disease
and osteoporosis (thinning of the bone) rises after menopause.
Understanding menopause and the range of treatment options can help
women make the best health decisions.
Remember, menopause is a perfectly natural occurrence.
The 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 menstrual periods. This usually happens
between the ages of 45 and 60, 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 flashes ÷
sudden intense waves of heat and sweating. Some women find that these
hot flashes disrupt their sleep, and others report mood changes. Other
symptoms may include irregular periods, vaginal or urinary tract
infections, urinary incontinence (leakage of urine or inability to
control urine flow), and inflammation 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, digestive tract, and hair during menopause.
In the long term, some women experience problems linked to the low
levels of estrogen found after menopause. These may include osteoporosis
and increased risk for heart disease.
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 flashes 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. It also
helps protect the heart and veins by increasing 'good cholesterol' (HDL
or high-density lipoprotein) and lowering 'bad cholesterol' (LDL or
low-density lipoprotein). 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:
- Stimulate the growth of a
cushiony lining in the uterus where the fertilized egg can grow and
develop into a baby
- Help the breast make milk
- Generally maintain
pregnancy
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 symptoms are hot flashes and vaginal atrophy (this is,
the tissue of the vagina becomes thinner, drier, and more delicate, and
begins to shrink).
Irregular bleeding
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:
- Bleeding occurs more often
than 21 days
- Your period lasts longer
than 8 days or is very heavy
- Your period occurs after 6
months or more without a period
Hot flashes
Hot flashes are the classic sign of menopause, as well as the most
common reason for seeking treatment. A hot flash 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 flashes last anywhere from a few seconds to several minutes. How
often they occur varies from woman to woman. Women who have had a
hysterectomy are more likely to have hot flashes. Many women experience
most of their hot flashes in the first 2 years after menopause, and find
that the hot flashes gradually lessen. However, some women have hot
flashes for several years before menopause, and some have them for 10,
20, or even 40 years or longer after menopause.
Hot flashes can affect a woman's social life and work. Also, hot flashes
that occur during the night can disrupt sleep. In fact, some women
report that their bed sheets become dampened or even soaked with sweat
when they have a hot flash during the night.
Factors that may be linked to
hot flashes
- Hot, humid weather
- Confining spaces
- Drinks or food with
caffeine or alcohol
- Spicy foods
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
The brain also responds to estrogen. In fact, estrogen is now
thought to be important in memory and the healthy functioning of nerve
cells in the brain. Some studies have shown that estrogen replacement
therapy can preserve brain activity and even improve memory.
Depression may also be more likely in the years right 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).
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
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.
Factors that increase the
risk for osteoporosis
- Caucasian or Asian race
- Slim build
- Cigarette smoking
- Family history (a mother,
sister, or aunt with osteoporosis)
- Early menopause
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:
- Being overweight (obesity)
- High blood pressure
- Diabetes
- Cigarette smoking
- High levels of "bad"
cholesterol
- A low level of activity
(sedentary lifestyle)
The use of estrogen replacement
therapy has been shown to dramatically reduce the risk for heart
disease. Estrogen can lower high levels of "bad" cholesterol and helps
maintain healthy veins. It may also help lower blood pressure and play a
role in keeping blood sugar close to normal levels. Some experts believe
that estrogen replacement therapy may be the single most important
factor in preventing heart disease in women.
Frequently Asked Questions
Will these symptoms last for the rest of my life?
For most women, the symptoms of menopause last for a relatively
short time. However, a woman's level of estrogen naturally remains low
after menopause. This can affect many parts of the body, including the
sexual and urinary organs, the heart, and the bones. So in that sense,
the changes of menopause will be lifelong. But eating right, exercising,
and making other positive lifestyle changes can help a woman feel great
and live a long, healthy life after menopause.
Is a change in sexual desire normal after menopause?
Many women say that their sexual desire lessens during the time of
menopause. In many cases, the cause is physical. For instance, because
lower estrogen levels sometimes cause physical changes in a woman's
sexual organs, having sex may become uncomfortable or painful so it is
important to find out whether there is a physical cause for lack of
desire. For some women, taking hormones called androgens can help
restore sexual desire.
Some women find that sexual desire changes because of how they feel
about themselves during menopause. Counseling and support groups can
help women learn strategies for coping with the physical and emotional
changes that occur during menopause.
What can be done to relieve pain during sex?
Intercourse may be painful when there is not enough moisture in the
vagina or when the tissue lining the vagina becomes fragile because of
lower estrogen levels in the body. Several methods are available to
relieve pain during intercourse. It may sound surprising, but frequent
sexual activity is one of the most effective remedies for vaginal
dryness. Other remedies include taking a warm bath before intercourse or
using lubricants. Short-acting, water-based lubricants, such as K-Y
Jelly, supply moisture and are used immediately before intercourse.
These products are readily available in grocery stores and pharmacies,
usually at a low cost.
Long-acting vaginal moisturizers are also available, and can provide
extended relief. Vaginal creams containing estrogen are very helpful in
relieving the symptoms of menopause, including vaginal dryness.
Since I began menopause, I've had an embarrassing problem - urine
leaks when I laugh or cough. What can be done to prevent this?
Some women have problems with bladder control after menopause
begins. This happens because the muscles that surround the bladder and
hold the urine inside become weaker when estrogen levels are low.
Fortunately, simple exercises - known as Kegel exercises - can
strengthen these muscles. To perform a Kegel, contract the pelvic
muscles as if trying to tighten or close the vaginal opening. Hold the
contraction for a count of three and then relax. Wait a couple of
seconds and repeat. Fast Kegels (squeezing and relaxing muscles as
quickly as possible) can also help. Performing several Kegels a day (try
for a total of 50 per day) can markedly improve bladder control - and
may even enhance sexual pleasure! Taking estrogen can also help maintain
the tone or strength of pelvic muscles.
My doctor has recommended hormone replacement therapy, but I've heard
that I'll have menstrual periods again if I take it. Is that true?
Estrogen therapy may cause vaginal bleeding in some women. This
depends on the hormone that is selected and the dose taken each day, as
well as each woman's own unique response to therapy. Often, estrogen is
taken in a cyclic regimen - that is, estrogen is taken for 21 to 25 days
of the month followed by several days without estrogen. After menopause,
low estrogen levels result in a thinning of the uterine lining, which,
in turn, stops the monthly period. Taking estrogen after menopause
thickens the uterine lining. This lining is shed on the days when
estrogen is not being taken, resulting in vaginal bleeding similar to a
period. About two-thirds of women who still have a uterus will have a
period on the days when they are not taking estrogen. Similarly, most
women who take continuous estrogen (that is, estrogen every day) plus
progestin pills on some days of the month will have a period.
If I have a period on estrogen therapy, will I also have PMS again?
Some women do experience PMS-like symptoms, including swollen or
tender breasts, bloating, nausea, and sometimes even a blue mood. Some
of these symptoms are linked to mild water retention, and may be
relieved by a mild diuretic. Other things that can help include:
-
Reducing salt intake
- Increasing exercise and
activity
- Avoiding caffeine and
chocolate
- Taking vitamin B6 or B
complex
Even though my eating habits
have not changed, I've gained weight recently. Is that linked to
menopause?
It may be. The body's metabolism changes during and after menopause.
Everyone's metabolism begins to slow during the early to mid-30s. This
change occurs slowly, so it may take a while for the impact of eating
habits to affect weight. It is important to make a sensible, nutritious
diet and healthy behaviors, such as getting enough exercise, a goal for
life.
I seem to be very forgetful lately and I'm worried. What's happening?
Many menopausal women have problems with short-term memory - like
forgetting the location of car keys or eyeglasses, skipping appointments
they didn't remember, or losing the end of a thought when speaking or
writing. These may be due to a busy lifestyle and/or stress at home or
work. Notably, several medical studies have shown distinct differences
in memory in women who have active ovaries producing estrogen or are
taking estrogen replacement therapy compared to women with low levels of
estrogen due to menopause.
How will menopause affect my daily activities and lifestyle?
That all depends on you. Menopause is a natural part of life, not a
disease or a health crisis. However, menopause may occur when many other
changes are happening in your. For instance, your children may be
marrying or leaving home, your parents may be ill or dying, or you may
be wondering what you'll do when you retire from work. That's why it is
probably more helpful to think of how your daily activities and
lifestyle will affect menopause. For instance, making sure that you
exercise and eat right can make a real difference in how you feel and
can even help prevent some of the long-term effects that are linked to
estrogen deficiency (like heart disease or osteoporosis).
Physical changes do occur with menopause and with aging. But the changes
that happen during this period can be minimized by healthy living and a
sense of purpose in life. |
