Menopause & Women's Health
April 25, 2011
Dr. Larry D. Gurley
News notes via www.webmd.com
Understanding Menopause -- the Basics
What Is Menopause?
Menopause simply means the end of menstruation. As a woman ages, there is a gradual decline in the function of her ovaries and the production of estrogen. Around the time a woman turns 40, this process speeds up. This menopause transition is known as perimenopause.
Women typically menstruate for the last time at about 50 years of age. A few stop menstruating as young as 40, and a very small percentage as late as 60. Women who smoke tend to go through menopause a few years earlier than nonsmokers. Most women notice some menstrual changes -- such as periods occurring closer together, skipped menstrual periods, and occasional heavy periods -- up to a few years before menstruation ceases.
There is great variation in how different women experience menopause. About 75% of women have hot flashes. Nighttime hot flashes are more common and may result in chronic sleep deprivation. Mood changes aren't as well understood, but some women report an obvious change in mood. In addition, women may experience vaginal dryness, painful intercourse, and urinary symptoms. These symptoms are often temporary and pass as your body adjusts. Hormone replacement therapy -- HRT for short -- can help relieve the symptoms in the meantime.
Perimenopause, or menopause transition, is the stage of a woman's reproductive life that begins several years before menopause, when the ovaries gradually begin to produce less estrogen. It usually starts in a woman's How 40s, but can start in a woman's 30s or even earlier as well.
Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last one to two years of perimenopause, this decline in estrogen accelerates. At this stage, many women experience menopausal symptoms.
Long Does Perimenopause Last?
The average length of perimenopause is four years, but for some women this stage may last only a few months or continue for 10 years. Perimenopause ends the first year after menopause (when a woman has gone 12 months without having her period).
What Are the Signs of Perimenopause?
You will know you are transitioning into menopause when you begin experiencing some or all of the following symptoms:
How Do I know If Changes in My Periods Are Normal Perimenopausal Symptoms or Something to Be Concerned About?
Irregular periods are common and normal during perimenopause. But, other conditions can cause abnormalities in menstrual bleeding. If any of the following situations apply to you, see a doctor to rule out other causes:
Potential causes of abnormal bleeding include hormonal imbalances, birth control pills, pregnancy, fibroids, blood clotting problems or, rarely, cancer.
How Is Perimenopause Diagnosed?
Often your doctor can make the diagnosis of perimenopause based on your symptoms. Blood tests to check hormone levels may also be beneficial but may be difficult to evaluate due to erratic fluctuations of hormones during this period. It may be more helpful to have several tests done at different times for comparison.
Can I Get Pregnant If I Am Perimenopausal?
Yes. Despite a decline in fertility during the perimenopause stage, you can still become pregnant. If you do not want to become pregnant, you should continue to use some form of birth control until you reach menopause (meaning you have gone 12 months without having your period).
For some women, getting pregnant can be difficult once they are in their late 30s to early 40s due to a decline in fertility. But, if becoming pregnant is the goal, there are fertility-enhancing treatments and techniques that can help you get pregnant.
WebMD Editors' Picks: News and Trends in Menopause
Are There Treatments That Can Reduce the Symptoms Associated With Perimenopause?
Many women experience relief from hot flashes after taking low-dose birth control pills for a short period of time. Other options that may control hot flashes include the birth control skin patch, vaginal ring, and progesterone injections. But, certain women should not use birth control hormones, so talk to your doctor to see if they are right for you.
You may also feel better if you do things that enhance your general well-being, such as:
Talk to your doctor if you are experiencing problems with your sex drive. He or she may be able to recommend a counselor or therapist to help you and your partner work through this issue. Vaginal lubricants may also be recommended, if vaginal dryness is a problem.
Additional treatments available to help with the various symptoms of perimenopause may include antidepressant medications for mood swings.
What Causes Menopause?
A woman is born with a finite number of eggs, which are stored in the ovaries. The ovaries also produce the hormones estrogen and progesterone, which regulate menstruation and ovulation. Menopause occurs when the ovaries no longer produce an egg every month and menstruation stops.
Menopause, when it occurs after the age of 40, is considered "natural" and is a normal part of aging. But, some women can experience menopause early, either as a result of surgery, such as hysterectomy, or damage to the ovaries, such as from chemotherapy. Menopause that occurs before the age of 40, regardless of the cause, is called premature menopause.
How Does Natural Menopause Occur?
Natural menopause is the permanent ending of menstruation that is not brought on by any type of medical treatment. For women undergoing natural menopause, the process is gradual and is described in three stages:
What Conditions Cause Premature Menopause?
Premature menopause can be the result of genetics, autoimmune disorders, or medical procedures. Here are some other conditions that may cause early menopause.
What Are the Symptoms of Menopause?
Most women approaching menopause or who are postmenopausal will experience hot flashes, a sudden feeling of warmth that spreads over the upper body that is often accompanied by blushing and some sweating. The severity of hot flashes varies from mild in most women to severe in others.
Other common symptoms experienced around the time of menopause include:
Not all women get all of these symptoms.
How Do I Know When I Am Going Through Menopause?
When you begin to notice the signs of menopause, either you'll suspect the approach of menopause on your own, or your doctor will put two and two together when you report your symptoms. Two very simple tests can accurately determine what's going on and what stage of menopause you're in. Your follicle stimulating hormone (FSH) levels will dramatically rise as your ovaries begin to shut down; these levels are easily checked through one blood test.
In addition, your vaginal walls will thin, and the cells lining the vagina will not contain as much estrogen. Your doctor will simply take a Pap-like smear from your vaginal walls -- simple and painless -- and analyze the smear to check for vaginal "atrophy," the thinning and drying out of your vagina. It helps if you keep track of your periods and chart them as they become irregular. Your menstrual pattern will be an added clue to your doctor about whether you are pre- or perimenopausal.
What Long-Term Health Problems Are Associated With Menopause?
The loss of estrogen associated with menopause has been linked to a number of health problems that become more common as women age.
After menopause, women are more likely to suffer from:
There are a number of treatments to consider that can reduce the risks associated with menopause.
Treatment of Menopause Symptoms
Are There Any Treatments for Symptoms of Menopause? There are a number of different treatment options to consider if you're suffering from symptoms of menopause.
Lifestyle changes. A healthy diet and regular exercise program will go a long way towards minimizing the symptoms of menopause and helping to maintain overall good health. It is also a good idea to finally kick any old, unhealthy habits, such as smoking or drinking too much alcohol. Other interventions that may be helpful are to dress lightly and in layers and avoid potential triggers like caffeine and spicy foods.
For vaginal dryness, moisturizers and nonestrogen lubricants such as KY Jelly, Replens, and Astroglide are available. Remaining sexually active may also help to preserve the lining of the vagina.
Prescription medication. Treatment with estrogen and progesterone, called combination hormone replacement therapy (HRT), can be prescribed for women who still have their uterus to reduce the symptoms of menopause and help prevent osteoporosis. Estrogen alone is the prescribed regimen for women who have had a hysterectomy (no longer have their uterus).
In the past, HRT was widely recommended for the treatment of menopausal symptoms as well as in the prevention of osteoporosis and heart disease. A large study known as the Women's Health Initiative (WHI) shed new light on how HRT is viewed.
According to the WHI study results, long-term combination HRT increases the risk of heart disease, breast cancer, blood clots, and stroke. Estrogen-only HRT was found to increase the risk of blood clots and stroke but did not worsen a woman's chance of getting breast cancer or heart disease. Although the WHI study found an increase in the risk of heart disease in women taking combination HRT, a more recent study suggests this finding may not be relevant to all postmenopausal women.
This study, published in the January/February 2006 issue of The Journal of Women's Health showed that the risk of heart disease demonstrated in the WHI may be related more to the advanced age of the participants as opposed to the HRT. The study also found that HRT given to younger women, at the onset of menopause, appeared to decrease the risk of heart disease.
Another study, published in the February 13, 2006 issue of the Archives of Internal Medicine, looked at nearly 11,000 women aged 50 to 79 taking only estrogen. Researchers reported no overall difference in heart attack risk among women who took the hormone and those who did not. In addition, there appeared to be a lower overall risk of heart disease in the women who began taking the estrogen between the ages of 50 and 59, suggesting a heart-healthy benefit to taking the therapy, if begun at a younger age.
Finally, a study published in the March 5, 2008 issue of the Journal of the American Medical Association reported on WHI participants three years after they stopped combination HRT therapy. The researchers found that "many of the health effects of hormones such as increased risk of heart disease are diminished, but overall risks, including risks of stroke, blood clots, and cancer, remain high." The study also concluded that the increased risk of breast cancer appears to linger and "other effects of combination hormones, such as decreased risk of colorectal cancer and hip fractures, also stopped when therapy ended."
More studies are underway to investigate the relationship between HRT and heart disease. In addition, many women may not be candidates for HRT. These women include those with current or past breast or uterine (endometrial) cancer, blood clots, liver disease, stroke, women who may be pregnant, or who have undiagnosed vaginal bleeding.
The current recommendations for women who are candidates for HRT due to bothersome symptoms of menopause is to take the lowest dose of hormones needed to relieve the symptoms of menopause and/or prevent osteoporosis. It is recommended to limit the use of the hormones to the shortest time period and, as with any prescription medication, HRT should be re-evaluated every six to 12 months. Hormonal patches, creams, gels, and vaginal rings may be alternatives to the traditional pills.
If you are unable or do not want to take hormones, there are other medications that your doctor can prescribe to alleviate some of the symptoms of menopause. These may include antidepressants for mood swings and difficulty sleeping. Other medications such as clonidine and gabapentin can help to reduce hot flashes related to menopause. These medications may also be used in addition to HRT in some cases. Talk with your doctor about what is best for you.
Alternative therapies. There are many unproven methods for alleviating menopausal symptoms, some may be more effective than others. Acupuncture, meditation, and relaxation techniques are all harmless ways to reduce the stress of menopause, and some people report great benefit from these practices. Many women also try herbal -- or natural -- remedies, like Remifemin (black cohosh), dong quai, and ginseng. Talk to your doctor before taking any of these therapies.