Menopause

Alternate Names
change of life
climacteric



Definition of Menopause

Menopause is the point in a woman's life when menstruation stops for twelve or more months. After menopause, a woman is no longer able to concieve a child. The average age of menopause among women in the United States is about 50 years, but the age range may vary from as early as 35 to as late as 56. Menopause is a natural event in a woman's life, with the exception of surgical menopause which occurs when a woman has both of her ovaries removed.

What is going on in the body?

By the time a woman is in her mid 30s, the level of the hormone estrogen in her body begins to drop. Levels gradually decline until a woman stops menstruating. The period during which estrogen levels are dropping but the woman is still menstruating is called perimenopause.

The point at which the estrogen level has declined enough so that menstruation stops twelve or more months is called menopause. Once a woman is menopausal she will remain menopausal for the rest of her life.

What are the signs and symptoms of the condition?

Symptoms of menopause vary from woman to woman. Some women will have severe symptoms. Others will have mild symptoms or none at all. The symptoms may occur for a few weeks, a few months, or even several years. The symptoms may come and go. Some common physical symptoms include:

• disturbed sleep patterns, or other sleep disorders
• hot flashes, which are a sudden sensation of heat in the whole body or in the upper part of the body
• short-term memory changes
• more frequent urination
• night sweats
• pain during sexual intercourse, known as dyspareunia

If a woman is menopausal, she doesn't have any further menstrual periods. Therefore, any bleeding after menopause is diagnosed must be evaluated by a healthcare provider who will evaluate the woman's endometrium (the lining of the uterus).

Women who are menopausal do not experience any more mental illnesses than any other group. However, the following psychological symptoms are common during menopause:

• anxiety
• depression
• difficulty remembering things
• irritability
• lack of concentration
• less desire for sex
• sleeplessness
• tearfulness

Menopause usually occurs during a time in life when other dramatic changes are taking place. Common changes during midlife include:

• becoming a grandparent
• changing careers
• starting retirement
• losing a parent
• having children grow up and leave home

These changes along with the changes going on in a woman's body during menopause may result in increased stress.

What are the causes and risks of the condition?

Menopause is a natural part of a woman's life. A woman's estrogen level decreases over time, causing her to stop menstruating. Once a woman is menopausal she will not be able to become pregnant. A woman who has her ovaries removed because of disease will go through surgical menopause.

What can be done to prevent the condition?

There is no prevention. All women who live long enough will experience cessation of menses, although not all women will have symptoms of menopause.

How is the condition diagnosed?

Diagnosis is usually made by the woman's medical history and supporting symptoms. A blood test can be used to measure a hormone produced in the hypothalamus called follicle stimulating hormone (FSH) may, on occasion, be helpful. When the ovaries stop working the level of this hormone builds up and can indicate menopausal change has occurred. However, this test is not considered diagnostic of menopause. Also, a pelvic exam and Pap smear may show effects of decreased estrogen.

What are the long-term effects of the condition?

Certain diseases are associated with estrogen loss in women. Thinning of the bone (osteopenia and osteoporosis) as well as urinatry tract infections are associated with menopause. The lack of estrogen can also cause thinning of the vagina (vaginal atrophy) and drying of the vagina - leading to vaginal symptoms or discomfort during sexual intercourse.

Many women have more desire for sex after menopause. This may be because pregnancy is no longer a worry. However, women who are still menstruating, and women who have stopped menstruating within the past year, may still get pregnant. Birth control during the perimenopause transition may prevent pregnancy.

What are the risks to others?

Menopause is not catching. It poses no risks to others.

What are the treatments for the condition?

Menopause itself is not treated.

Certain health problems, such as osteopenia or osteoporosis, which are linked to the loss of estrogen, can be prevented with diet, exercise and medications.

When the symptoms of menopause are moderate to severe, prescription estrogen, with or without progesterone, called hormone therapy (HT) may be very helpful. This therapy is also called estrogen therapy (ET) or estrogen/progestin therapy (EPT).

There is much controversy about the possible risks of HT, including breast cancer, blood clots, heart attack, and stroke. Therefore, the decision to use HT should be based upon the proven benefits and risks of HT. A woman should discuss the benefits and risks with her doctor. Together, they can choose the best course of action.

During menopause, sexual intercourse may become painful, a condition known as dyspareunia. This condition is often caused by vaginal drying, and can result in a decline in sexual interest. Creams are available to help with lubrication.

Kegel's exercises of the pelvic muscle may reduce urinary leakage. Surgery or medicine may also be used.

Hot flashes are the most common and disruptive of menopause symptoms. When severe or frequent or causing a disturbance of sleep patterns, a health care professional should be consulted. He or she may suggest treatments such as hormone therapy (HT), which is the most effective treatment for hot flashes.

Yet, because of concerns about HT, many women utilize natural medicines (herbs, vitamins or supplements) for hot flashes.

The Natural Medications Comprehensive Database (NMCD) concludes that soy has the most evidence for effectiveness and may be worth trying. Soy foods are preferred over soy supplements which have concentrated isoflavones.

The NMCD also concludes that the use of black cohosh has less evidence than soy, but might help some women. They also report there is not enough safety or efficacy data to recommend unopposed transdermal progesterone, bioidentical hormone therapy, or testosterone.

Furthermore, the NMCD concludes that there not enough safety or efficacy data to recommend red clover, DHEA, flaxseed, chasteberry, kudzu, alfalfa, hops, licorice, evening primrose, Panax ginseng, wild yam, or vitamin E for hotflashes and that dong quai should not be used due to safety concerns.

The North American Menopause Society does not recommend dong quai, evening primrose oil, ginseng, licorice, Chinese herb mixtures, acupuncture, or magnet therapy for hot flash relief due to a lack of evidence supporting their use.

What are the side effects of the treatments?

Side effects to HT can include headaches, bloating, vaginal bleeding, breast tenderness, and irritability. Recent studies have also linked HT, in certain circumstances, to an increased risk of heart attack, stroke, and cancers of the breast, ovary, and uterus.

If you decide to use alternative therapies, the American College of Obstetricians and Gynecologists (ACOG) reminds you to be sure to tell your physician. ACOG says that some natural medicines have the potential to cause drug interactions with other medications you are using.

Remember, too, that dietary supplements, including herbal products, are not as strictly regulated by the federal government as are prescription and over-the-counter drugs. As a result, potency may vary from product to product, or even from batch to batch of the same product.

Bear in mind that just because alternative therapies are referred to as ‘natural' remedies doesn't mean they're without risks or side effects. For this reason, you should take the same care when using alternative supplements or products as you would when using any over-the-counter or prescription medication.

What happens after treatment for the condition?

Most menopausal symptoms will go away once menstruation stops.

How is the condition monitored?

A woman's progress through menopause is monitored through regular Pap smears and pelvic exams. Any new or worsening symptoms should be reported to the doctor.