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Menopause

What is it?

Menopause is the time in a women’s life when menstruation stops. Menopause is usually a gradual process. The ovaries begin to produce lower amounts of hormones. The reduced amounts of hormones cause menstrual periods to become irregular and eventually to stop completely. The hormonal changes often cause other symptoms. Menopause can also occur when the ovaries are surgically removed.

Who gets it and what are its causes?

The average American woman will go through menopause at the age of 51. Most women will finish menopause between the ages of 42-48. A smaller number of women will find that their periods stop prematurely, before age 40. If menopause (hormonal changes at the end of the female reproductive years) occurs before age 40, it is said to be premature menopause. There are several causes of menopause. Women who have premature menopause often have autoimmune disorders like thyroid disease or diabetes mellitus. In these diseases, the body produces antibodies to one or more of its own organs. These antibodies interfere with the normal function of the organ. Just as antibodies might attack the thyroid or the pancreas, antibodies may attack the ovaries and stop the production of female hormones.

Cancer treatment like chemotherapy or radiation can cause premature menopause. The risk depends on the type and length of treatment and the age of the woman when she first begins radiation or chemotherapy.

Menopause usually occurs at a time in life when other dramatic changes take place. Some of these changes may include loss of parents, adjustment to children growing up and leaving home, becoming a grandparent, retirement or career changes. These changes, in addition to the changes in your body, may result in emotional or psychological stress. Psychological symptoms may include anxiety, depression, tearfulness, irritability, sleeplessness, less desire for sex, lack of concentration and more trouble remembering things.

What are the symptoms?

The most common symptom of menopause is a change in the menstrual cycle, but there are a variety of other symptoms as well, including:

Hot flashes
Night sweats
Insomnia
Mood swings/irritability
Memory or concentration problems
Vaginal dryness
Heavy bleeding
Fatigue

Depression
Hair changes
Headaches
Heart palpitations
Sexual disinterest
Urinary changes
Weight gain

If the ovaries are surgically removed (during a hysterectomy, for example), menopause will occur in a few days, no matter how old the woman.

Diagnosis

Menopause can often be diagnosed through your medical history. Your health care provider will then examine you. A pelvic exam and Pap smear may show the effects of decreased estrogen. The clearest indication of menopause is the absence of a period for one year. It is also possible to diagnose menopause by testing hormone levels.

Medical Treatment

Anti-estrogens-A new type of hormone therapy offers some of the same protection against heart disease and bone loss as estrogen, but without the increased risk of breast cancer.

The best known of these anti-estrogens is raloxifene, which mimics the effects of estrogen in the bones and blood, but blocks some of its negative effects elsewhere. It's called an anti-estrogen because for a long time these drugs had been used to counter the harmful effects of estrogen that caused breast cancer. Oddly enough, in other parts of the body these drugs mimic estrogen, protecting against heart disease and osteoporosis without putting a woman at risk for breast cancer.

Like estrogen, raloxifene works by attaching to an estrogen "receptor," much like a key fits into a lock. When raloxifene clicks into the estrogen receptors in the breast and uterus, it blocks estrogen at these sites. This is the secret of its cancer-fighting property. (Many tumors in the breast are fueled by estrogen; if the estrogen can't get in, then the cancer can't grow.)

Women may prefer to take raloxifene instead of hormone replacement because the new drug doesn't boost the breast cancer risk and doesn't have side effects like uterine bleeding, bloating, or breast soreness. Unfortunately, the drug may worsen hot flashes. Raloxifene is basically a treatment to prevent osteoporosis. It doesn't help with common symptoms and it is unclear if it has the same protective effect against heart disease as estrogen does.

Testosterone replacement-The ovaries also produce a small amount of male hormones, which decreases slightly as a woman enters menopause. The vast majority of women never need testosterone replacement, but it can be important if a woman has declining interest in sex. Testosterone can improve the libido, and decrease anxiety and depression; adding testosterone especially helps women who have had hysterectomies. Testosterone also eases breast tenderness and helps prevent bone loss.

However, testosterone does have side effects. Some women experience mild acne and some facial hair growth, but because only small amounts of testosterone are prescribed, most women don't appear to have extreme masculine changes.

Birth control pills-Women who are still having periods but who have annoying menopausal symptoms may take low-dose birth control pills to ease the problems; this treatment has been approved by the FDA for perimenopausal symptoms in women under age 55. HRT is the preferred treatment for menopause, however, because it uses lower doses of estrogen.

Alternative treatment-Some women also report success in using natural remedies to treat the unpleasant symptoms of menopause. Not all women need estrogen and some women can't take it. Many doctors don't want to give hormones to women who are still having their periods, however erratically. Indeed, only a third of menopausal women in the United States try HRT and of those who do, eventually half of them drop the therapy. Some are worried about breast cancer, some can't tolerate the side effects, some don't want to medicate what they consider to be a natural occurrence.

Herbs-Herbs have been used to relieve menopausal symptoms for centuries. In general, most herbs are considered safe, and there is no substantial evidence that herbal products are a major source of toxic reactions. But because herbal products aren't regulated in the United States, contamination or accidental overdose is possible. Herbs should be bought from a recognized company or through a qualified herbal practitioner.
Women who choose to take herbs for menopausal symptoms should learn as much as possible about herbs and work with a qualified practitioner (an herbalist, a traditional Chinese doctor, or a naturopathic physician). Pregnant women should avoid herbs because of unknown effects on a developing fetus.

What concerns some critics of other alternative remedies is that many women think that "natural" or "plant-based" means "harmless." In large doses, phytoestrogens can promote the abnormal growth of cells in the uterine lining. Unopposed estrogen of any type can lead to endometrial cancer, which is why women on conventional estrogen-replacement therapy usually take progesterone (progestin) along with their estrogen. However, a plant-based progesterone product can sometimes be effective alone, without estrogen, in assisting the menopausal woman in rebalancing her hormonal action throughout this transition time.

Yoga-Many women find that yoga (the ancient meditation/exercise developed in India 5,000 years ago) can ease menopausal symptoms. Yoga focuses on helping women unite the mind, body, and spirit to create balance. Because yoga has been shown to balance the endocrine system, some experts believe it may affect hormone-related problems. Studies have found that yoga can reduce stress, improve mood, boost a sluggish metabolism, and slow the heart rate. Specific yoga positions deal with particular problems, such as hot flashes, mood swings, vaginal and urinary problems, and other pains.

Exercise-Exercise helps ease hot flashes by lowering the amount of circulating FSH and LH and by raising endorphin levels (which drop while you're having a hot flash). Even exercising 20 minutes three times a week can significantly reduce hot flashes.

Elimination-Regular, daily bowel movements to eliminate waste products from the body can be crucial in maintaining balance through menopause. The bowels are where circulating hormones are gathered and eliminated, keeping the body from recycling them and causing an imbalance.

Acupuncture-This ancient Asian art involves placing very thin needles into different parts of the body to stimulate the system and unblock energy. It is usually painless and has been used for many menopausal symptoms, including insomnia, hot flashes, and irregular periods. Practitioners believe that acupuncture can facilitate the opening of blocked energy channels, allowing the life force energy (chi) to flow freely. This allows the menopausal woman to keep her energy moving. Blocked energy usually increases the symptoms of menopause.

Acupressure and massage-Therapeutic massage involving acupressure can bring relief from a wide range of menopause symptoms by placing finger pressure at the same meridian points on the body that are used in acupuncture. There are more than 80 different types of massage, including foot reflexology, Shiatsu massage, or Swedish massage, but they are all based on the idea that boosting the circulation of blood and lymph benefits health.

Menopause is a natural condition of aging. Some women have no problems at all with menopause, while others notice significant unpleasant symptoms. A wide array of treatments, from natural to hormone replacement, mean that no woman needs to suffer through this time of her life.

Menopause is a natural part of the aging process and not a disease that needs to be prevented. Most doctors recommend HRT for almost all post-menopausal women, usually for a few years. When HRT is then stopped, symptoms should be mild or non existent. But HRT is not only useful in lessening the symptoms of menopause; it also protects against heart disease and osteoporosis.

Surgical Treatment

There is no surgical treatment to stop or reverse menopause. By using the medical treatments mentioned above, a woman should be able to be to continue her normal life through her menopause years.

Physicians Who Treat Menopause

This information has been designed as a comprehensive and quick reference guide written by our health care reviewers. The health information written by our authors is intended to be a supplement to the care provided by your physician. It is not intended nor implied to be a substitute for professional medical advice.

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