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What is Menopause?
You may think of menopause as the time when your menstrual periods stop permanently. According to medical professionals, menopause is officially marked when a woman has gone 12 months without getting her period. Menopause isn’t a one-time event like our elders may have described it, rather it is an ongoing process. It is not a single event, rather, it’s a progression of changes that can begin in one’s 30s or 40s and continue into one’s 50s or even 60s.
Menopause is a regular physiological process, and should not be perceived as an illness or disease. Although it’s associated with hormonal, physical, and psychosocial changes in your life, menopause isn’t the end of your youth or your sexuality. Several generations ago, few women lived beyond menopause. Today, you may spend as much as half of your life after menopause.
Fortunately, much more is known about menopause now than was known when your mother and grandmother experienced it. You can do more to relieve bothersome symptoms, avoid complications and improve your health and vigor during this important phase of your life.
Signs and Symptoms of Menopause
Every woman experiences menopause differently. Every woman has her individual timeline for experiencing menopause, so the age it happens to you can be unique. Some women reach menopause in their 30s or 40s, and some not until their 60s, but menopause most often occurs between the ages of 50 and 51.
Your signs and symptoms are also likely to be very individual. You may breeze through menopause with few signs and symptoms. Or you may experience a number of physical and emotional changes, including:
Your cycle may stop suddenly, or gradually get lighter or heavier and then stop. The unpredictability of your periods may be your first clue that menopause is approaching.
When ovulation begins to fluctuate, you’re less likely to become pregnant. Until you haven’t had a period for a year, however, pregnancy is still possible.
As estrogen levels drop, the tissues inside your vagina and urethra (the opening to your bladder) become drier, thinner, and won’t stretch as much. With decreased lubrication, you may experience burning or itching, along with an increased risk of infections of your urinary tract or vagina. Sexual intercourse may become uncomfortable or even painful due to these changes.
As your estrogen level drops, your blood vessels may expand rapidly, causing your skin temperature to rise. This can lead to a feeling of warmth that moves upward from your chest to your shoulders, neck, and head. You may sweat, and as the sweat evaporates from your skin, you may feel chilled, weak, and slightly faint. Your face might look flushed, and red blotches may appear on your chest, neck, and arms. Most hot flashes last from 30 seconds to several minutes, although they can last much longer. Hot flashes can appear at different levels of intensity and for varying lengths of time, depending on the individual. They may occur frequently, such as every hour or only occasionally. These situations can take place at any hour, be it during the day or at night. They may be a part of your life for a year or more, or you may never have them.
Hot flashes may cause night sweats, which is a common symptom. Waking up in the middle of the night feeling soaked in a cold sweat, accompanied by chills. You may have difficulty falling back to sleep or achieving deep, restful sleep. Not getting enough sleep can have detrimental effects on your mood and overall well-being.
After menopause, the fat that had once resided in your hips and thighs can migrate to your abdomen and waist area. With time, you may observe a decrease in the volume of your breasts, thinning hair, and wrinkles on your skin. If you have a history of acne in your adulthood, it may become exacerbated. Estrogen production may diminish as you age, but your body will still produce a small amount of
testosterone. Consequently, you may experience hairs growing on your chin, upper lip, chest, and abdomen in a slightly rougher texture.
As you go through menopause, you may experience mood swings, be more irritable or be more prone to emotional upsets. In the past, these symptoms were attributed to hormonal fluctuations. Yet other factors may contribute to these changes in mood, including
stress,
insomnia, and life events that can occur in this stage of adulthood such as the illness or death of a parent, grown children leaving home, and retirement.
What Causes Menopause?
Menopause begins naturally when your ovaries start making less estrogen and progesterone. During your reproductive years, these hormones regulate your monthly cycles of ovulation and menstruation. In your late 30s, the amount of progesterone your body produces diminishes, and the remaining eggs from your ovaries are less likely to be fertilized. Eventually, your menstrual periods stop, and you can no longer become pregnant. Because this process takes place over years, menopause is commonly divided into the following two stages:
This is the time you begin experiencing menopausal signs and symptoms even though you’re still ovulating. Your hormone levels rise and fall unevenly, and you may have hot flashes and variations in your periods. For instance, your flow may be irregular, heavier, or lighter than usual. This is a normal process leading up to menopause and may last four to five years or more.
Once 12 months have passed since your last period, you’re considered postmenopausal. The ovaries in a postmenopausal woman’s body can no longer secrete the hormones estrogen and progesterone, nor are they capable of releasing eggs.
What are the Risk Factors for Menopause?
Menopause is usually a natural process. Certain medical and surgical interventions can cause menopause to occur earlier than anticipated. These include:
A hysterectomy that removes your uterus but not your ovaries usually doesn’t cause menopause. Even though you’re no longer fertile, your ovaries still produce eggs on a regular basis. But an operation that removes both your uterus and ovaries (total hysterectomy and bilateral oophorectomy) does cause menopause. There’s no perimenopausal phase. Instead, your periods stop immediately, and you’re likely to have hot flashes and other menopausal signs and symptoms.
These cancer therapies can induce menopause. However, the symptoms of perimenopause tend to appear gradually and can persist for months or even years before menopause is reached.
How is Menopause Diagnosed?
Usually, you don’t need a laboratory test to confirm menopause. The signs and symptoms are enough to tell most women they have begun going through this process. If you experience any irregularities with your menstrual cycle or hot flashes, it’s recommended to consult with your doctor. In certain situations, it is necessary to eliminate any potential other issues
To analyze your FSH and Estradiol levels, your doctor can execute a simple blood test. It’s an effective way to monitor their quantity. As menopause occurs, FSH levels increase, and estradiol levels decrease. If you have an FSH level higher than 30 and an estradiol value lower than 20, it could be a sign that you have gone through menopause. If these levels are checked while you’re still taking birth control pills, these tests need to be done at the end of your hormone-free week.
How is Menopause Treated?
Menopause itself requires no medical treatment. Instead, treatments focus on relieving your signs and symptoms and on preventing or lessening chronic medical conditions that may occur during the postmenopausal years. Treatments include:
This therapy, which provides a low dose of estrogen, often in combination with progestin, has been shown to be effective in treating many of the signs and symptoms such as vaginal dryness, discomfort during intercourse, and hot flashes HRT may be taken in a variety of forms including a pill, patch, cream, or vaginal ring, and customized to fit each woman’s needs. Women who have had a hysterectomy take HRT as estrogen alone also referred to as estrogen replacement therapy (ERT).
Most other women who take HRT are advised to use a combination of estrogen and progestin because progestin helps protect against uterine cancer. HRT taken as estrogen alone or as a combination therapy protects against bone loss and osteoporosis. Oral ERT raises levels of high-density lipoprotein (HDL) cholesterol (the “good” cholesterol) and lowers levels of low-density lipoprotein (LDL) (the “bad” cholesterol). But not all effects of HRT are positive. Taking HRT as a combination therapy of estrogen plus progestin can result in serious side effects and health risks. Work with your doctor to discuss the options and decide what’s best for you.
Doctors use these nonhormonal medications, which include alendronate (
Fosamax) and risedronate (
Actonel), to prevent or treat osteoporosis. Although these medications don’t provide the same protection for your bones as estrogen does, they effectively reduce both bone loss and your risk of fractures. Alendronate may cause gastrointestinal problems and irritation of your esophagus.
SERMs are among a group of drugs that includes raloxifene (Evista). They have some of the beneficial effects of estrogen, especially improved bone strength, but no increased risk of breast cancer or uterine bleeding. But these medications tend to cause, rather than relieve, hot flashes, and increase your risk of blood clots and gallstones.
Discuss your treatment options with your doctor before deciding on anything. Ask about the possibilities, as well as any associated risks and advantages of each one.
Self-Care
Thankfully, the majority of issues that come up with menopause are not permanent and tend to go away over time. Take these steps to help reduce or prevent their effects:
If you’re experiencing hot flashes, get regular exercise, dress in layers, and try to pinpoint what triggers your hot flashes. For many women, triggers may include hot beverages, spicy foods, alcohol, hot weather, and even a warm room.
For vaginal dryness or discomfort with intercourse, use over-the-counter water-based vaginal lubricants (Astroglide, K-Y Jelly) or moisturizers (
Replens,
Vagisil). Staying sexually active also helps minimize these problems.
If you have trouble sleeping, avoid caffeinated beverages and exercise right before bedtime. Taking time to breathe deeply and using guided imagery or simple muscle relaxation techniques can be incredibly helpful in calming down and reducing stress levels. There is a wide range of books and; audio tapes available on various relaxation techniques.
If you experience night sweats, wear cool cotton clothing to bed and keep an extra set handy.
Doing Kegel exercises regularly can be extremely helpful in treating urinary incontinence as it strengthens the pelvic floor muscles.
Eat a balanced diet that includes a variety of fruits, vegetables, and grains and that limits fats, oils, and sugars. In particular, make sure your intake of calcium is at least 1,200 to 1,500 mg. If you’re not taking estrogen, ask your physician about additional
calcium supplements.
Smoking increases your risk of heart disease,
stroke, cancer, and a range of other health problems. It may also increase hot flashes and bring on earlier menopause.
Thirty minutes most days is a good goal to protect against
cardiovascular disease,
diabetes, and
osteoporosis. It also can help reduce stress. Try a combination of weight-bearing aerobic activities, such as walking, jogging, dancing, and strength-training exercises. Making simple changes like taking the stairs instead of the elevator or parking farther away can be a great way to stay physically active every day.
Talk with your doctor about how often you should have mammograms, Pap tests, and other screening tests.
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