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The Facts About Menopause

Ninni JI, Chair of Obstetrics & Gynecology, Obstetrician & Gynecologist

Menopause is the transitional period in a woman’s life when she stops menstruating. This time marks the end of the reproductive years that begin in puberty.

The thought of entering menopause may be cringe-inducing, however, some women consider menopause the start of their second youth, so all depends on your perspective.

When Does Menopause Occur?

The onset of Menopause occurs at different times for each individual depending on factors such as heredity, environment and history of pelvic surgeries and infertility treatments. In the United States, the average age for women entering menopause is 51.

From puberty to the onset of menopause, the ovaries produce estrogen, one of the female hormones. Estrogen causes the endometrium (the lining of the uterus) to thicken every month. In the middle of each menstrual cycle, an egg is released from the ovaries – this is ovulation. After ovulation, levels of another female hormone, progesterone, rises. If a pregnancy does not take place, levels of both estrogen and progesterone decrease, causing the lining of uterus to shed. This uterine lining is purged during menstrual bleeding.

The years leading up to menopause are called perimenopause (meaning “around menopause”). For most women, perimenopause lasts an average of 2 years, but could be as long as 5 years.

During perimenopause, the ovaries gradually begin to produce less estrogen. Ovulation becomes infrequent in most women, leading to irregular menstrual cycles. Skipping one or two cycles is common and the menstrual flow may also taper down. At some point, the ovaries stop producing enough estrogen to thicken the lining of the uterus. This signals the start of menopause.

What Happens To My Body During Menopause?

Menopause is a natural part of aging. The lower amounts of estrogen will cause changes in a woman’s body over time. Some women notice little difference in their bodies while others may find it difficult to cope with the changes.

Starting from menopause, women may experience the following symptoms or changes:

Hot flashes

A hot flash is a sudden feeling of heat rushing to the upper body and face. 75% of women experience hot flashes during menopause. Some will have hot flashes for a few months and some for a few years. A hot flash can be strong enough to wake a person up from a deep sleep.

Sleep problems

Some women have less rapid eye movement, known as REM sleep, during menopause. REM sleep makes up about 20% of an adult’s normal sleep cycle. Without REM sleep, one may wake up without feeling rested. Getting to sleep may also take longer.

Emotional changes

Menopause does not cause depression. However, changes in hormone levels may make women feel nervous, irritable or tired more frequently. These feelings may be linked to lack of sleep. Women under high levels of stress may find menopause more difficult to cope with.

Changes in the vagina and urinary tract

The falling estrogen levels may cause the vaginal lining to become thin and dry. Pain during sex and increased suspectibility to vagina infections may occur.

The urinary tract changes too. The urethra can become dry or irritated. Some women find that they need to urinate more often. Women may also experience an increased risk of bladder infection.

Sexuality

Lower hormone levels may decrease sex drive. Some women find they have less interest in sex around, during or after menopause. It may affect one’s ability to have an orgasm, or it may take longer reach orgasm. But menopause does not have to affect the ability to have or enjoy sex. Lack of estrogen can make the vagina drier, but vaginal lubricants can make sex more comfortable.

Changes in the bones and other parts of the body

During menopause, the rate of bone loss increases. Osteoporosis can increase the risk of breaking bones for older women. The bones of the hip, wrist, and spine are affected most often.

The estrogen produced by a woman’s ovaries before menopause also protects her from heart attacks and stroke. Because less estrogen is made after menopause, women lose most of this protection. The risk of heart attack and stroke increases.

Treatment for Menopause

Menopause is a natural part of aging. However, if you are experiencing very uncomfortable symptoms, there are treatment options at your disposal.

Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy can relieve the symptoms of menopause by replacing the female hormones. The new estrogen slows down bone loss, helps to prevent osteoporosis and reduces the risk of colon cancer. HRT is often prescribed in the form of pills, vaginal rings, or skin patches.

Like any treatment, HRT is not free of risks. Estrogen is usually given along with progestin, a synthetic version of the hormone progesterone, because estrogen taken alone can increase the risk of uterine cancer. The drawback of using progestin is that it may increase the risk of breast cancer. Menopausal women using HRT may also start bleeding again for a short time.

The Women’s Health Initiative, a 15-year study by the National Institutes of Health (NIH), raised concerns about the risks that hormone products pose to postmenopausal women. The study results suggested that the increased risk of health problems from hormone therapy may vary from woman to woman depending on how far a woman is past menopause. For example, a woman who is 15 years past menopause may be at greater risk for adverse effects than a woman 2 years past menopause. Because of these research findings, the U.S. Food and Drug Administration (FDA) announced that all products for postmenopausal women containing estrogen should have a warning label stating that prolonged use could increase the risk of heart attacks, strokes, blood clots and breast cancer.

Therefore, the patient and her doctor should always decide together if this treatment is right. The patient should take the smallest dose of hormone therapy possible, for the shortest amount of time possible. Women who are prescribed HRT drugs to treat vaginal dryness may want to consider using a topical cream or gel product instead.

Other therapies

There are other options for preventing menopause related bone loss. These include bisphosphonates or selective estrogen receptor modulators (SERMs). A medication called calcitonin slows the breakdown of bones. Bisphosphonates are used to increase bone density and reduce the risk of fractures. Parathyroid hormone also is used for this purpose.

Women can take SERMs to strengthen bone tissue and to help treat or prevent some of the bone loss. SERMs may be a good choice for women who need protection from osteoporosis but cannot or do not want to undergo hormone therapy.

Women today can expect to live one-third of their lives after menopause, and physical changes that occur around menopause should not prevent them from enjoying this time of their lives. Remember that menopause is a natural event. To be in optimum health, remember to exercise regularly, eat a balanced diet with adequate calcium and see the doctor for routine check-ups.

References: 

National Institutes of Health: www.nih.gov

American Congress of Obstetricians and Gynecologists: www.acog.org

Women’s Health Initiative: www.nhlbi.nih.gov/whi