Menopause Fundamentals

Menopause is the time in a woman’s life when monthly periods stop for 12 consecutive months. Often referred to as the change of life, the body begins to slowly make less of the hormones estrogen and progesterone because of the decline in ovarian function. This usually happens between the ages of 45 and 55, but because every woman is unique, it can occur earlier or later. The diversity of changes at menopause can be confusing. Some women never have any symptoms at all, while others are bombarded with unpleasant symptoms, making the transition particularly wearisome. Not only do symptoms differ from woman to woman, but they may differ from month to month. Common symptoms include:

• A change in the pattern of the menstrual cycle. Periods may be longer or shorter, lighter or heavier – with more or less time between periods
• Hot flashes (flushes) and night sweats
• Difficulty sleeping, resulting in fatigue
• Vaginal dryness and changes in sexual desire (usually diminished)
• Mood swings, feeling out–of–sorts and irritable, having crying jags
• Having trouble focusing, being confused at times when you normally would not
• Hair loss or thinning on your head and more growth of facial hair
• Bone loss since the body is not producing as much estrogen

What is Perimenopause?
Perimenopause is the precursor to menopause. It can last for as long as 5 to 15 years, and many women experience more symptoms during perimenopause than after menopause. It is the time before periods actually stop completely, when ovarian hormone production is declining and fluctuating, causing a host of symptoms. The symptoms vary, but the common denominator is change. Periods may be longer or shorter, heavier or lighter, or more painful. Although this condition is better recognized than it was in the past, many women’s symptoms are overlooked or ignored.

What is Premature Menopause?
Premature menopause occurs when menses stop before a woman reaches age 40. It may be brought on by:

• A family history (genetic)
• Medical treatments like surgery to remove the ovaries
• Cancer treatments like chemotherapy or radiation

Racial Differences
Studies show that the experience of menopause differs among racial groups. For example, in one study hot flashes occurred in about 45% of African Americans and 30% of Caucasians. Hispanic women tended to notice urine leakage and vaginal dryness. Japanese and Chinese women experienced far fewer menopausal symptoms, except for forgetfulness. All ethnic groups notice more forgetfulness.

Treatment
Lifestyle adjustments may help reduce menopausal symptoms. These include quitting smoking, avoiding or minimizing spicy foods, caffeine and alcohol, all of which may trigger hot flashes. In addition, behavioral strategies such as lowering stress levels with relaxation techniques and exercising regularly can reduce symptoms. Finally, wearing loose clothing or dressing in layers helps so that you can remove top layers can help to cool you down during a hot flash.

Hormone replacement therapy (HRT) may be used to treat hot flashes and night sweats, and improve quality of life in perimenopause or menopause. In some women, hot flashes can have a tremendous negative effect on quality of life. They tend to occur at night and cause sleep deprivation, which can cause fatigue and mood changes. HRT is very effective in treating hot flashes, which can last for several years in some women.

There are some risks to using HRT, and therefore experts recommend that it should be taken in smallest possible dose for the shortest time to relieve symptoms of the menopause. Any woman on HRT should be reviewed annually to check whether she should still be taking it. This is because risks may begin to outweigh the benefits as use becomes longer, over years. Despite the risks, women with the most severe symptoms often feel it is worth the risks associated with hormone replacement therapy, and find relief.

Some other benefits of hormone replacement include thickening of the vagina, and a decrease in vaginal dryness, pain with intercourse and urinary incontinence. You can, however, use a local estrogen that’s not absorbed in to the body and therefore has fewer risks, to manage some of those effects.

Concerns about the HRT involve the increased risk of developing breast cancer, cardiovascular disease, blood clots, and stroke, especially after long–term use. Women previously treated for breast cancer are generally advised not to use HRT.

Non–hormonal treatments for hot flashes are another alternative, especially for women with a history of breast cancer or medical condition in which estrogen is contraindicated. Selective serotonin reuptake inhibitors (SSRI’s) are a class of medication used for depression. Studies show that low doses of SSRI’s are effective in decreasing hot flashes. There are many different SSRI’s available, and it seems likely that all the SSRI’s work equally effectively.

Healthy Aging
Menopause is part of a healthy aging process, so treating it like a disease doesn’t make sense. Learning how to manage symptoms in a way that is as natural as possible should be the norm, so women learn to embrace growing older and find ways to maintain their sense of humor and self.