MEDICAL MONDAYS NEWS NOTES
Dr. Larry D. Gurley
The Menopause Center at Baptist
Dr. Gurley's practice specializes in menopause and menstrual disorders.
TOPIC: Menopause & Perimenopause
Monday, April 21, 2008
Menopause is the point in a woman's life when she has not had a menstrual period for 1 year. Menopause marks the end of the childbearing years. It is sometimes called "the change of life."
For most women, menopause happens around age 50, but every woman's body has its own timeline. Some women stop having periods in their mid-40s. Others continue well into their 50s.
Perimenopause is the process of change that leads up to menopause. It can start as early as your late 30s or as late as your early 50s. How long perimenopause lasts varies, but it usually lasts from 2 to 8 years. You may have irregular periods or other symptoms during this time.
Menopause is a natural part of growing older. You don't need treatment for it unless your symptoms bother you. But it's a good idea to learn all you can about menopause. Knowing what to expect can help you stay as healthy as possible during this new phase of your life.
What causes menopause?
Normal changes in your reproductive and hormone systems cause menopause. As your egg supply ages, your body begins to ovulate less often. This causes your hormone levels to go up and down unevenly (fluctuate), causing changes in your periods and other symptoms. In time, estrogen and progesterone levels drop enough that the menstrual cycle stops.
What are the symptoms?
Common symptoms include:
Some women have only a few mild symptoms. Others have severe symptoms that disrupt their sleep and daily lives.
Symptoms tend to last or get worse the first year or more after menopause. Over time, hormones even out at low levels, and many symptoms improve or go away. Then you can enjoy being free from periods and birth control concerns.
Do you need tests to diagnose menopause?
You don't need to be tested to see if you have started perimenopause or reached menopause. You and your doctor will most likely be able to tell based on irregular periods and other symptoms.
If you have heavy, irregular periods, your doctor may want to do tests to rule out a serious cause of the bleeding. Heavy bleeding may be a normal sign of perimenopause. But it can also be caused by infection, disease, or a pregnancy problem.
You may not need to see your doctor about menopause symptoms. But it is important to keep up your annual physical exams. Your risks for heart disease, cancer, and bone thinning (osteoporosis) increase after menopause. At your yearly visits, your doctor can check your overall health and recommend testing as needed.
Do you need treatment?
Menopause is a natural part of growing older. You don't need treatment for it unless your symptoms bother you. But if your symptoms are upsetting or uncomfortable, you don't have to suffer through them. There are treatments that can help.
The first step is to have a healthy lifestyle. This can help reduce symptoms and also lower your risk of heart disease and other long-term problems related to aging.
If lifestyle changes are not enough to relieve your symptoms, you can try other measures, such as:
If you have severe symptoms, you may want to ask your doctor about prescription medicines. Choices include:
All medicines for menopause symptoms have possible risks or side effects. A very small number of women develop serious health problems when taking hormone therapy. Be sure to talk to your doctor about your possible health risks before you start a treatment for menopause symptoms.
Remember, it is still possible to become pregnant until you reach menopause. To prevent an unwanted pregnancy, keep using birth control until you have not had a period for 1 full year.
Menopause and Perimenopause - Cause
As you age, your body begins the natural sequence of changes that eventually bring an end to your menstrual cycle (menopause). The number and quality of your eggs decline, hormone levels fluctuate, and your menstrual cycle becomes less predictable. This time of unpredictable change is called perimenopause.
Menopause and postmenopause
After a few years of fluctuating hormones, your estrogen and progesterone levels begin to decline. When your estrogen drops past a certain point, your menstrual cycle and your ability to become pregnant end. After 1 year with no menstrual bleeding, you reach menopause and begin postmenopause.
A year or more into postmenopause, estrogen levels typically even out at a low level. Since estrogen also plays a role in other functions of your body, its decline has far-reaching effects, including faster bone loss and drying and thinning of the skin and the vaginal and urinary tracts.
Causes of early menopause
Your body has its own timeline for when menopause will start and how long it will last. In fact, it's likely that your timeline will be much like your mother's was. However, certain lifestyle choices and medical treatments can cause or are linked to an earlier menopause, including:
Although some women have few or no menopause symptoms, most women do. Similarly, while some women have mild symptoms, others find that their sleep, daily life, and sense of well-being are severely affected. Menopause symptoms eventually subside when hormone levels even out. Postmenopause changes are normal signs of low estrogen and typically continue over time.
Signs and symptoms of perimenopause
Signs that you are in perimenopause include:
Symptoms of menopause
Symptoms related to menopause are caused by changing or dropping hormone levels and usually end 1 or 2 years after menopause. Some women continue to have symptoms for 5 or more years afterward. Menopause symptoms include:
Menopause caused by surgery, chemotherapy, or radiation therapy can cause more severe symptoms than usual.6 Preexisting conditions such as depression, anxiety, sleep problems, or irritability can get worse during the perimenopausal transition.
Signs of postmenopause
Signs that you have reached menopause and are in postmenopause include:
Other conditions can cause changes in the menstrual cycle or symptoms resembling perimenopause and postmenopause. Examples include pregnancy, a significant change in weight, depression, anxiety, disease, or uterine, thyroid, or pituitary problems.
Menopause is a natural change that doesn't require treatment. However, symptoms of hormonal change can be difficult. If you have insomnia, mood swings, hot flashes, cloudy thinking, heavy menstrual periods, or other menopause symptoms, treatment can help you manage this transition more comfortably. As you review your options, consider the following:
Recent studies have led to a big change in how health professionals use hormone therapy after menopause. For a long time, estrogen-progestin, or hormone replacement therapy (HRT), was thought to protect against heart disease or dementia. But studies now show that HRT use can cause serious health problems in a small number of women. These health problems include dangerous blood clots, stroke, heart disease, breast cancer, ovarian cancer, and dementia.8, 9, 10 The heart disease risk does not seem to affect women during their first 10 years after menopause.11
Average HRT- and ERT-related risks are low among the general population of women. However, your personal risk that hormone therapy may stimulate breast cancer, ovarian cancer, cardiovascular problems, blood clots, or neurological changes may be lower or higher, depending on your risk factors for those health problems.
Treatment options for menopause symptoms
Hot flashes. Meditative breathing exercises (paced respiration) have been shown to reduce hot flashes.1 Medications that can improve hot flashes include short-term, low-dose hormone therapy, selective serotonin reuptake inhibitor (SSRI) antidepressants such as fluoxetine and paroxetine (for example, Paxil and Prozac), the high blood pressure medication clonidine, and the antiseizure medication gabapentin (Neurontin).12, 13
Heavy periods. The hormone progestin can help relieve heavy menstrual bleeding caused by low progesterone levels (after you have an exam to rule out other possible causes). Other options include nonsteroidal anti-inflammatory drugs (NSAIDs), the levonorgestrel (LNg) IUD, or birth control pills. For severe blood loss, some women choose permanent surgical treatment. These options include removing the uterus (hysterectomy) or using heat energy to damage and scar the wall of the uterus (endometrial ablation). For more information, see the topic Dysfunctional Uterine Bleeding.
Vaginal dryness and irritation. A vaginal lubricant can help with dryness. Estrogen creams, rings, or tablets can help thin skin, dryness, and irritation. Less estrogen is absorbed into your system with vaginal use, so the risks associated with ERT are less likely.
Multiple or severe symptoms. Hormone therapy can relieve multiple or difficult menopause symptoms. For symptom relief before menopause, low-dose estrogen-progestin birth control pills or low-dose HRT (estrogen-progestin) can reduce heavy menstrual bleeding and other symptoms. After menopause, low-dose HRT is an option. Also, for severe symptoms that don't improve with estrogen-progestin, there is an estrogen-testosterone therapy. But testosterone is not FDA-approved for women, because it is not yet well studied. Talk to your health professional about short-term HRT along with checkups every 6 months.
Bioidentical hormone replacement therapy (BHRT) is an alternative to HRT. But it has not been well studied. The hormones are made in a laboratory from wild yams or soy. BHRT is thought to be more similar to human-produced hormones than synthetic HRT is. (Well-designed studies have yet to prove this theory.14) However, bioidentical HRT may carry the same heart, stroke, blood clot, breast cancer, ovarian cancer, and dementia risks that are linked to traditional HRT. Any form of hormone therapy, including BHRT, is best taken for as short a period as possible after menopause.
Testosterone is sometimes used to increase sexual desire in postmenopausal women who have low testosterone. The U.S. Food and Drug Administration (FDA) has not approved testosterone treatment for this purpose. Studies of testosterone in women have not lasted longer than 6 months.15 FDA experts want to know more about long-term risks before they approve testosterone for female use.
If you have a problem with low sexual desire, consider that most sexual problems in women relate to such things as relationship troubles, depression, or medicine side effects. For more information, see the topic Sexual Problems in Women.
Other treatment options
Because of concern about HRT health risks, many women have turned to alternative medicine for menopause symptom relief.