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Health Information
Menopause
Definition
Menopause is the
time when the menstrual period ceases and
the ovaries permanently stop releasing eggs.
Menopause is considered complete when a
woman has been without her period for a full
year. Although menopause can occur anytime
between ages 40 to 58, the average age is 51
years old.
Causes
Natural
menopause is a gradual process. The ovaries
begin producing lower amounts of estrogen
and other steroid hormones prior to
menopause during a phase called
peri-menopause.
When menopause
occurs before the age of 40 it is called
premature menopause. Premature menopause can
occur naturally but may also be the result
of several conditions, including:
- Family
history of premature menopause
- Autoimmune
diseases
-
X-chromosome abnormalities
- Medical
treatments (pelvic surgery, surgical
removal of ovaries,
chemotherapy, or pelvic radiation
therapy)
- Medications
that lower estrogen levels
- Smoking
Risk Factors
A risk factor is
something that increases your chance of
getting a disease or condition. As menopause
is a natural process associated with aging,
there are no risk factors. Risk factors for
premature menopause include:
- Family
history of premature menopause
Symptoms
As menopause
approaches, women often experience a number
of physical and emotional symptoms
including:
- Irregular
menstrual periods
- Hot flashes
and night sweats
- Disturbed
sleep patterns, insomnia
- Anxiety
- Significant
mood changes
-
Depression
- Dry skin
-
Irritability
- Vaginal
dryness and pain with sexual intercourse
- Difficulty
concentrating
- Trouble
remembering things
- Diminished
interest in sex
- Frequent
urination or leaking of urine
- Headaches
- Achy joints
- Fatigue
- Early
morning awakening
Diagnosis
The doctor will
ask about your symptoms and medical history,
and perform a physical exam. The doctor may
perform blood tests, a pelvic exam, and a
Pap smear. Natural menopause is usually
diagnosed when a woman has not had a
menstrual period for 12 consecutive months.
Some women have
had a
hysterectomy before menopause, and they
no longer have periods. For these women, if
menopause is suspected but needs
confirmation, the test considered most
accurate for the diagnosis of menopause is
the measurement of follicle stimulating
hormone (FSH). High levels of FSH (greater
than 40) may indicate menopause.
Treatment
Menopause is a
natural part of life and does not
necessarily require treatment. Symptoms and
health risks associated with low estrogen
can be treated. These include hot flashes,
vaginal dryness, and
osteoporosis (loss of bone mass).
Hormone Replacement Therapy (HRT)
A number of
different types of hormones are
available. They include natural,
synthetic, and plant-derived estrogens
and progesterone; combinations of
estrogen and progesterone; or the
addition of small amounts of male
hormones. Hormone preparations are
available as tablets, gels, skin
patches, vaginal rings, vaginal tablets,
injections, and pellets inserted into
the skin. There is now significant
scientific evidence that the global
health risks associated with combined
estrogen and progestrogen HRT on a
long-term basis (>3-5 years) outweigh
the benefits for many women. The average
age of the women in these research
studies is over 60 years old. Use of
combined HRT at the time of menopause
(around age 50) is believed to pose less
risk. Furthermore, most of these studies
used conjugated estrogens and
medroxyprogesterone. Other evidence
suggests that use of estradiol and
natural progesterone may pose less risk.
Phytoestrogens
A high
intake of phytoestrogens (or plant
estrogens) may help menopausal women.
They may reduce the risk for diseases
associated with estrogen. Phytoestrogens
are found in soybeans, black cohosh,
whole grains, legumes, tempeh, and flax
seed. They are also found in
concentration in capsule form.
Healthful Diet
A healthful
diet during menopause can improve a
woman's sense of well-being. It may also
reduce the risk of heart disease,
osteoporosis, and certain cancers. The
diet should be low in fat and high in
fruits, vegetables, whole grains,
calcium, and vitamin D.
Limit Caffeine and Alcohol
Cutting back
on caffeine and alcohol may reduce
symptoms of anxiety, insomnia, and loss
of calcium.
Quit Smoking
Giving up
smoking can reduce the risk of early
menopause, heart disease, and
osteoporosis.
Regular Exercise
Regular
exercise may reduce hot flashes.
Weight-bearing exercises such as
walking, climbing stairs, and resistance
exercises such as lifting weights help
strengthen bones and decrease the risk
of osteoporosis.
Stress Management
Stress
management may help ease tension,
anxiety, and possibly other menopausal
symptoms. Deep breathing, massage, warm
baths, and quiet music are examples of
relaxation techniques.
Over-the-Counter Products
Moisturizers
and lubricants are used to help vaginal
dryness.
Nonhormonal Medications
Certain
blood pressure medicines taken in lower
doses than are used to treat
high blood pressure have been
somewhat helpful in relieving some
menopausal symptoms such as hot flashes.
These medicines include clonidine (Catapres)
and methyldopa (Aldomet).
SSRI
medications (serotonin reuptake
inhibitors like Prozac, Paxil, and
Effexor) have been shown to have modest
impact on hot flash severity scores.
These medications should not be used if
you are taking tamoxifen to reduce your
risk of
breast cancer recurrence.
Prevention
Menopause is a
natural biologic event that does not need to
be prevented. Quitting smoking could
slightly delay the onset of menopause.
RESOURCES:
American College of Obstetricians and
Gynecologists
www.acog.org
National Women's Health Resource Center
www.healthywomen.org
The North American Menopause Society
www.menopause.org
CANADIAN RESOURCES:
The Canadian Women's Health Network
www.cwhn.ca/indexeng.html
Women's Health Matters
www.womenshealthmatters.ca/index.cfm
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