- DR. ROBERTA WATTLEWORTH, chairwoman of the family practice department at Des Moines University, writes a monthly column for Health.Even though it is a normal part of life, menopause is a strange and daunting event for women. It is often misunderstood, feared or ignored. It is hoped the following information will help you understand what it is and how to deal with it.
- What is menopause?Every woman is born with a set number of eggs in her ovaries. These eggs remain immature and inactive until puberty. At this point, the pituitary gland stimulates the ovaries to cause some eggs to mature and be released from the ovaries. The egg(s) travel down the fallopian tubes, through the uterus, and out the vagina if fertilization does not take place. During this trip, the hormones estrogen and progesterone are produced in varying quantities by the ovaries. If the egg is not fertilized, the progesterone level drops off, which triggers the lining of the uterus to shed. This is called menstruation, or more commonly referred to as having a period. The number of eggs in the ovaries diminishes with age, contributing to some fertility problems in women over 40. As the ovaries age, less estrogen may be produced, which can cause periods to become more irregular as menopause approaches. By definition, menopause occurs when a woman has not had a period for 12 consecutive months, except when the lack of periods is caused by pregnancy followed by breast-feeding, or a medical disorder such as anorexia nervosa. Most women experience menopause between the ages of 45 to 55, with the average age being 51. Many women go through this phase at approximately the same age their mothers did. About 1 percent of women stop having periods before age 40; this is called premature ovarian failure. The cause is unknown, but it appears to be genetically linked. It also has been associated with autoimmune disorders such as thyroiditis or rheumatoid arthritis. The approach and beginning of menopause is called perimenopause or the climacteric. Even though the ovaries are less active, and periods more irregular, egg production still takes place. Women who rely on natural family planning or nonhormonal forms of contraception need to be aware that pregnancy still can take place during the perimenopausal time. Once complete, a woman is considered "postmenopausal." The process is different for each woman. Some stop having periods very abruptly, while some have irregular periods for several years.These periods may consist of light spotting or near hemorrhage conditions at irregular intervals anywhere from two weeks to several months apart.
One reason many women dread menopause is that 70 percent of women experience at least some of the more than 30 common symptoms associated with it. The following are some of the most frequently occurring symptoms:
- Hot flashes: Sudden surges of warmth that spread over the upper torso and face, often accompanied by a flushing of the skin and sweating. Flashes can last from 30 seconds to several minutes, and can wake up women from a sound sleep.
- Menstrual irregularities: As mentioned previously, some women abruptly stop menstruating and some have a four- to five-year phase with periods every two weeks to every four months. Although most cases of irregular menstrual bleeding in the late 40s or early 50s are due to menopause, you should consult a physician if it occurs. Irregular bleeding also could be a sign of endometrial (uterine) cancer.
- Vaginal dryness: Estrogen keeps the lining of the vagina moist. When estrogen drops during menopause, the vaginal tissues can become thin, dry and less elastic. Sexual intercourse can result in discomfort because of dryness, and at times the tissue will tear. Nonhormonal treatment for vaginal dryness includes lubricants such as KY jelly.
- Urinary incontinence: Sometimes urine will leak during coughing, sneezing or heavy lifting.
- Diminished sex drive (loss of libido): Both men and women can lose interest in sex with aging.
- Changes in hair: Hair follicles also are influenced by estrogen, so menopause may involve loss of scalp and pubic hair.
- Osteoporosis: The thickness, or density, of our bones starts to gradually diminish during the fourth decade of life. All women should have a bone density study performed before perimenopause to get a baseline level, followed by a repeat test in two years.
- Sleep disturbances: Studies have found that women have twice the rate of insomnia during menopause than before. Night sweats are a common cause of sleep disruption.TreatmentsMenopause is a natural process women must go through. A woman who has her uterus surgically removed will stop having periods, but the ovaries still will produce hormones. In her late 40s or early 50s, she still will experience typical menopause symptoms. A woman who has both her uterus and ovaries surgically removed will undergo a "surgical menopause" and may experience symptoms such as hot flashes, vaginal dryness, thinning of hair and mood fluctuations - at times quite severe because of the abrupt hormone change.
- Hormone replacement therapy involves replacing one or both of the female hormones estrogen and progesterone. This is a common way of treating the symptoms of menopause.
- Nonhormonal prescriptions - low-dose antidepressants (especially in the class called selective serotonin reuptake inhibitors), gabapentin and clonidine (an anti-hypertension drug) can be used to treat hot flashes.
- The use of plant-derived therapies to reduce menopausal symptoms is being studied by the National Center for Complementary and Alternative Medicine. Plants being studied include black cohosh, dong quai, ginseng, kava, red clover and soy extracts.Although use of these has not been supported with scientific research, they do give options for relief of symptoms for women who are unable or unwilling to take hormone replacement therapy.